José Roberto LambertucciI; Izabela VoietaI; Izabela dos Santos SilveiraII
ICurso de Pós-Graduação em Ciências da Saúde: Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG IIServiço de Anatomia Patológica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG
A 26-year-old woman reported a history of severe headache followed by seizures five days before being admitted to hospital. She was first examined by a physician in her town in the northeast of Minas Gerais (Brazil), who diagnosed anxiety and prescribed benzodiazepine. Since the seizures persisted, her family decided to bring her to a specialized health center in Belo Horizonte, to seek proper diagnosis and treatment. In our hospital, a computed tomograph (CT) scan of the brain showed a contrast-enhanced tumor mass in the left parietal and frontal lobes, surrounded by edema (Figure A – arrow). Axial contrast-enhanced T1-weighted MR imaging showed a focal multinodular pattern (Figure B – arrows)3. A biopsy fragment from the brain tumor, examined under optical microscopy (H&E 400x), revealed the presence of Schistosoma mansoni egg shells surrounded by proliferative granulomata (Figure C – arrow)2. She was started on schistosomiasis treatment with praziquantel (60mg/kg of body weight, in a single dose), followed by prednisone (80mg/day) for seven days to treat the cerebral edema. She was discharged from hospital 10 days later in a good general condition. Two months later, she was reexamined at the outpatient clinic and was found to be asymptomatic. No motor or sensory sequelae were caused by the biopsy or the brain tumor. After the treatment with diphenyl hydantoin was started, there were no reports of seizures.
REFERENCES
1. Braga BP, Costa Junior LB, Lambertucci JR. Magnetic resonance imaging of cerebellar schistosomiasis mansoni. Revista da Sociedade Brasileira de Medicina Tropical 36:635-636, 2003. [ Links ]
2. Lambertucci JR, Silva LC, Amaral RS. Guidelines for the diagnosis and treatment of schistosomal myeloradiculopathy. Revista da Sociedade Brasileira de Medicina Tropical 40:574-581, 2007. [ Links ]
3. Sanelli PC, Lev MH, Gonzalez RG, Schaefer PW. Unique linear and nodular MR enhancement pattern in schistosomiasis of the central nervous system: report of three patients. AJR American Journal of Roentgenology 177:1471-1474, 2001. [ Links ]
Address to:
Dr. José Roberto Lambertucci
Faculdade de Medicina/UFMG
Av. Alfredo Balena 190
30130-100 – Belo Horizonte, MG, Brasil
email: lamber@uai.com.br
Recebido para publicação em 03/11/2008
Aceito em 10/11/2008
