Dados do Trabalho
SCHISTOSOMIASIS MYELORADICULOPATHY: CASE REPORT IN THE STATE OF SERGIPE
Apresentação do caso
AGRB, male, 9 years old, 52kg, previously healthy, born and raised in Pirambu, Bebedouro village, Sergipe. Admitted on 10/09/2022 to the pediatrics sector of the Sergipe Emergency hospital, reporting headache, fever and vomiting for 7 days, with subsequent evolution with pain in the posterior region of the right thigh, in addition to low back pain. Physical examination showed normal breathing and heart rate. Decreased strength in lower limbs, being worse on the left side. No patellar reflex and left Achilles. Normal right reflexes. Strength preserved in upper limbs. Presence of Babinski's sign on the right. No signs of trunk involvement. Inglês
During the medical evaluation, a magnetic resonance imaging (MRI) of the dorsal column was requested, with findings of multiple foci with heterogeneous gadolinium uptake affecting the central portion and anterior funiculi of the spinal cord from D8 to the medullary cone, with T2 hypersignal in the spinal cord parenchyma adjacent and extending to the D4 level, with mass effect, with partial erasure of the CSF column in correspondence. The vertebral bodies, joints and musculature had normal contours and structures. It was concluded, then, that the examination showed an inflammatory-type lesion with a focus on schistosomiasis with involvement of the spinal cord associated with epidemiological data and clinical suspicion. ollected CSF that showed total proteins in the amount of 128.6 mg/dL, 597 cells/mm3 (PNM: 14% and LMN: 86%) with positive IFI for schistosomiasis. Treatment with ivermectin 6 mg was started, administering 02 pills every 24 hours for 02 days. After ivermectin, pulse therapy was started with 01g/day of methylprednisolone for 05 days. After pulse therapy, a dose of praziquantel was started and prolonged corticosteroid therapy was maintained with prednisone 01 mg/kg/day for 06 months.
Schistosomiasis is considered endemic in 19 districts, one of which is the state of Sergipe, and the S. mansoni species, in addition to being the most prevalent, is also the one most associated with myeloradiculopathy. Diagnosis is based on: epidemiology, neurological symptoms, microscopic and serological techniques, and magnetic resonance imaging (MRI) evaluation. In addition, it is necessary to rule out other possible diagnoses. The symptomatology corroborates to determine the degree of involvement of the lesion.
Schistosomiasis is an important and endemic parasitic.
Referências (se houver)
1. ALVES, WALTER ALYSSON. PREVENÇÃO DA ESQUISTOSSOMOSE MANSÔNICA NA USF AGUILHADAS.
2. BRANDÃO, H. G. et al. Mielorradiculopatia esquistossomótica: relato de caso em paciente pediátrico. Medicina (Ribeirao Preto, Online), 2021.
3. CARVALHO, Otavio Augusto Moreno de. Mansonic neuroschistosomiasis. Arquivos de Neuro-Psiquiatria, v. 71, p. 714-716, 2013.
4. DANTAS DOS SANTOS, Allan et al. Análise do grau de implantação (GI) do programa de controle da esquistossomose mansônica (PCE) em um município endêmico do estado de Sergipe, Brasil. Rev. iberoam. educ. invest. enferm.(Internet), p. 40-49, 2015.
5. DE SOUZA ANDRADE FILHO, Antonio et al. Neuroesquistossomose. Revista Brasileira de Neurologia e Psiquiatria, v. 19, n. 3, 2015.
6. FRANCO, Karine Garcez Schuster et al. Association of IL-9, IL-10, and IL-17 cytokines with hepatic fibrosis in human Schistosoma mansoni infection. Frontiers in immunology, p. 5125, 2021.
7. KOLLAPEN, Kumeshnie et al. Medullary neuroschistosomiasis in a pediatric patient: a case report. Radiology Case Reports, v. 17, n. 3, p. 462-466, 2022.
8. MANAMAL, Nevitha Athikari et al. Neuroschistosomiasis: An Unusual Intracranial Space Occupying Lesion. Indian Pediatrics, v. 55, n. 11, p. 993-994, 2018.
9. OLIVEIRA, Lívia Souza de et al. Mielorradiculopatia esquistossomótica em região não endêmica. Revista Paulista de Pediatria, v. 38, 2020.
10. SALGADO, João Victor et al. Myeloradicular form of neuroschistosomiasis in a six-year-old boy infected with schistosoma mansoni. The Pediatric Infectious Disease Journal, v. 34, n. 12, p. 1409-1411, 2015.
11. SILVA, Bárbara Morgana da et al. High schistosomiasis-related mortality in Northeast Brazil: trends and spatial patterns. Revista da Sociedade Brasileira de Medicina Tropical, v. 55, 2022.
12. WEN, Sophie CH et al. Pediatric neuroschistosomiasis: a case report and review of the literature. Journal of the Pediatric Infectious Diseases Society, v. 8, n. 5, p. 489-491, 2019.
SCHISTOSOMOSIS ; NEUROINFECTION; MYELORADICULOPATHY
Fonte de Fomento (se houver)
Declaração de conflito de interesses de TODOS os autores
NÃO HÁ CONFLITOS DE INTERESSES
HOSPITAL UNIVERSITARIO DE SERGIPE - Sergipe - Brasil
RODRIGO SANTOS DE ARAUJO, MILENA MELO DE CASTRO, DANIEL OLIVEIRA SANTOS, FRANCIS SHARAYM MELO DE CARVALHO, SUELLEN REJANE LIMA SA, GABRIEL RIBEIRO ANDRADE NETO, RENE VASCONCELOS SILVA