Title : Neuroschistosomiasis in an adolescent presenting with seizure and headache: A case report
Abstract:
Background:Schistosomiasis, a neglected tropical disease, remains endemic in certain regions of the Philippines. This case highlights the importance of considering neuroschistosomiasis in the differential diagnosis of pediatric patients presenting with unexplained neurological symptoms, particularly those with relevant exposure history.
Clinical case:A 16-year-old Filipino male from Northern Samar, residing in Pasig City, presented with a 6month history of seizures and headaches. His initial seizure was generalized tonic-clonic, with upward rolling of the eyeballs and stiffening of extremities. Concurrent with seizure onset, he developed occasional, frontal headaches, which progressed in frequency, severity, and duration over time. He had notable exposure history: regular swimming in a river and consumption of snails, both risk factors for schistosomiasis.
Initial management focused on symptomatic treatment and other causes of seizure was entertained and ruled out. However, due to the patient's persistent symptoms and exposure history, neuroschistosomiasis was strongly suspected. Further workup, including Circumoval Precipitin Test (COPT) and Kato Katz Test were facilitated. Cranial MRI revealed findings suggestive of neuroschistosomiasis, and further confirmed by positive COPT. Dexamethasone was continued and started on Praziquantel Therapy for 5 days. No further seizure recurrence, headache, or vomiting was noted during the succeeding hospital days. The patient was discharged and advised for a repeat Cranial MRI after 2 weeks.
Conclusion:A high index of suspicion for neuroschistosomiasis should be considered in patients with relevant exposure to freshwater and snails. Early recognition and appropriate management can prevent long-term neurological sequelae associated with this parasitic infection.
