Schistosoma infection as a cause of myeloradiculopathy: case report from Mozambique and systematic review

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Background Schistosomal myelopathy (SM) is a rare and devastating neurological manifestation of schistosomiasis, predominantly affecting individuals in endemic regions. SM may present a wide range of positive and negative manifestations such as paresthesia, myalgia, low back pain, paraplegia and urinary dysfunction. Limited awareness and lack of access to supportive microbiological and imaging diagnostics means may delay clinical recognition. Methods Case report of SM and a systematic review of the literature on its epidemiological patterns and clinico-radiological characteristics, including cases published from inception to April 27, 2025. Results A 27-years-old man presented with chronic back pain, progressive paraparesis - modified Rankin 4, and urinary incontinence. Magnetic resonance imaging (MRI) revealed findings suggestive of inflammatory myelitis from T12 to L4, the cerebrospinal fluid (CSF) microscopy demonstrated the presence of Schistosoma eggs. The literature review identified additional 58 cases of SM. The median age was 25 years (range 2–65 years); most patients were males (79%), presenting with subacute and chronic disease. In the majority of cases, SM lesions involved the thoracolumbar region or conus medullaris. Schistosoma eggs were detected in 31% ( n = 37) of cases. Additional systemic manifestations, for instance bladder involvement, were reported in 64% ( n = 75). All patients received anthelmintic therapy and corticosteroids. At the end of follow up, 90% ( n = 107) were able to walk unassisted, while 10% remained dependent (modified Rankin scale ≥ 3). Conclusion Schistosomal myelopathy is a rare, aggressive neurological disorder primarily affecting young males. Even with appropriate medical therapy, a substantial proportion of patients remain functionally dependent (mRS ≥ 3). This emphasizes the critical importance of early recognition and prompt intervention to mitigate irreversible neurological impairment.

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