José Roberto Lambertucci; Sílvio Roberto Sousa-Pereira; Luciana Cristina dos Santos Silva
Serviço de Doenças Infecciosas da Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG
A 22-year-old man was admitted to hospital complaining of fever, diarrhea, low back pain radiating to the lower limbs, paresthesia and weakness, which started 2 days earlier. Forty days before onset of the present symptoms, he together with seven friends had bathed in a small river of a town located 100km to the north of Belo Horizonte, Minas Gerais state, Brazil. Three out of his seven comrades also developed fever and diarrhea and were admitted to another hospital. In all of them, S. mansoni eggs were identified in the stools. His neurological symptoms evolved rapidly with paraparesis (he was unable to walk without support) and urinary retention. Complete blood cell count revealed leukocytosis, and 924 eosinophils/mm3. Cerebral spinal fluid obtained by a lumbar tap showed 62 cells/mm3, and 8% eosinophils (5 cells). Magnetic resonance imaging (MRI) of the spinal cord detected moderate enlargement of the conus medullaris in a T1-weighted sequence with signal enhancement following intravenous gadolinium injection (Figure A, sagittal projection – arrow). In Figure B (arrow), in an axial projection after intravenous contrast administration, there was intense granular impregnation of the low thoracic spinal cord. The patient was treated with oral praziquantel (50mg/kg in a single dose) and received methylprednisolone (1g q.d.) for 5 days, followed by oral prednisone (1mg/kg, body weight) for 6 months. He improved quickly and 2 months later achieved complete recovery, without limitations. Yet, at the time, he still complained of slight paresthesia in the right leg.
1. Nobre V, Silva LC, Ribas JG, Rayes A, Serufo JC, Lana-Peixoto MA, Marinho RF, Lambertucci JR. Schistosomal myeloradiculopathy due to Schistosoma mansoni: report on 23 cases. Memórias do Instituto Oswaldo Cruz 96 (Suppl): 137-141, 2001.
2. Silva LC, Maciel PE, Ribas JG, Pereira SR, Serufo JC, Andrade LM, Antunes CM, Lambertucci JR. Schistosomal myeloradiculopathy. Revista da Sociedade Brasileira de Medicina Tropical 37: 261-272, 2004.
3. Silva LCS, Maciel PE, Ribas JGR, Sousa-Pereira SR, Antunes, CM, Lambertucci JR. Treatment of schistosomal myeloradiculopathy with praziquantel and corticosteroids and evaluation by magnetic resonance imaging: a longitudinal study. Clinical Infectious Diseases 39: 1618-1624, 2004.
Prof. José Roberto Lambertucci
Faculdade de Medicina/UFMG
Av. Alfredo Balena 190
30130-100 Belo Horizonte, MG, Brazil
Recebido para publicação em 1/4/2005
Aceito em 6/4/2005