A seven year old girl with Schistosoma mansoni infection of the spinal cord mimicking cord neoplasm is reported from the Department of Neurology, University of Michigan, Ann Arbor, MI. Exposure to Schistosomal parasites occurred while bathing in a river in Sierra Leone, Southern Africa. The illness presented with back and leg pain and a low-grade fever. Within 24 hours she had weakness of the leg and four days later she was unable to walk, to urinate or defecate. Sensation was diminished below the low thoracic area. CSF showed 2 RBCs, 250 WBCs with 78% lymphocytes, protein 584 mg/dl and glucose 55 mg/dl. Myelography revealed a large intramedullary mass at thoracic levels 11 and 12. MRI with Gadolinium demonstrated enhancement of the cord at T10 level through the conus. Decompressive laminectomy was performed with resection of a yellow gliotic appearing cord of neoplastic appearance. Histologic examination revealed eggs characteristic of S. mansoni. After treatment with praziquantel, lower extremity strength gradually improved and six months later, she was walking well with braces. [1]

COMMENT. In patients with acute or subacute paraparesis who have been exposed to endemic areas (South Africa, South America, Caribbean or the Middle East), schistosomiasis must be suspected. Spinal cord involvement can be delayed for up to six years after exposure, and findings on MRI and myelography may mimic spinal cord neoplasms. Patients with mild or early involvement of the spinal cord may be benefitted by antiparasitic medications alone and surgery may be unnecessary.