In patient 2, follow-up MRI showed a reduction in lesions and loss of gadolinium enhancement (Figure 2). The timeline for clinical signs and therapy for both patients is shown in Figure
3. The two patients living in La Réunion reported herein showed all the symptoms of acute schistosomiasis. Although La Réunion is part of Africa, autochthonous amebiasis or schistosomiasis is indeed absent in the Island since decades. Our two cases presented cercarial dermatitis (swimmer’s itch) after a freshwater exposure in an endemic area (Middle-Western Madagascar) followed by a generalized inflammatory reaction (Katayama fever), characterized NVP-BGJ398 mw by eosinophilia, urticaria, and fever. In both the patients, this syndrome was accompanied by neurological
symptoms. Moreover, considering the absence of E histolytica infection in their usual resident place and the evidenced risky behavior for food-borne disease transmission during their journey, the diagnosis of concomitant intestinal and invasive amebiasis was attempted. On the other hand, the diagnosis of S mansoni infection was confirmed by serological tests and the positive stool examination. The latter result accounts for a quite advanced evolution in the course of acute larval invasive phase, as stool parasitology for Schistosoma eggs JAK inhibitor is assumed not to contribute at this stage. Neuroschistosomiasis was diagnosed on the basis of clinical and radiological features. The involvement of the central nervous system (CNS) has rarely been reported during acute S mansoni schistosomiasis, and attention has been mainly focused on the pseudo-tumoral form of this infection.2 Acute invasive phase neurological complications should be distinguished from CNS involvement in
chronic schistosomiasis with erratic parasitic migration and schistosoma egg deposition in this tissue.3 When neurological symptoms appear concomitantly with Katayama fever, neuroschistosomiasis should be suspected and MRI should be performed. In the two patients, the mode of clinical presentation Fossariinae with acute monophase inflammatory demyelinating disorder of the CNS and the MRI multifocal lesion patterns were consistent with the characteristics of the postinfectious ADEM syndrome.4 Besides, the condition should be differentiated from possible neurotoxicity linked to adverse effect of metronidazole therapy.5 However, both of our patients experienced first neurological signs such as insomnia before the initiation of metronidazole. Moreover, despite the discontinuation of metronidazole, the cerebral condition of our two patients worsened making this hypothesis less likely. Herein, Schistosoma infection was assumed as the triggering event to be associated with the ADEM presentation. In fact, no other usual triggering factors such as upper respiratory tract infection or pre-travel vaccination were evidenced.