Résumé

Introduction: Cerebral schistosomiasis is a rare and potentially severe neurological complication of schistosomiasis. Its clinical and radiological presentation is nonspecific and may mimic a brain tumor. Histopathological examination can provide definitive confirmation when tissue is available. We report a case of cerebral schistosomiasis due to Schistosoma mansoni in a 40-year-old woman. Clinical case: A 40-year-old woman presented with chronic hemicranial headache, vomiting, and generalized tonic-clonic seizures evolving over seven years. Neurological examination revealed right-sided ptosis, right hemiparesis graded 4/5, a right extensor plantar response with an equivocal response on the left, and a Glasgow Coma Scale score of 15/15. Laboratory testing showed eosinophilia at 0.9 × 10³/µL. Brain computed tomography showed a left parietofrontal cortico-subcortical expansile lesion suggestive of glioblastoma. Magnetic resonance imaging demonstrated a necrotic-appearing left parietal intracranial lesion surrounded by marked edema with early subfalcine herniation. Histopathological examination revealed granulomatous inflammation composed of epithelioid histiocytes and multinucleated giant cells surrounding numerous calcified and viable schistosomal eggs, whose lateral spine was compatible with Schistosoma mansoni. Ziehl-Neelsen staining highlighted the egg shell in red-pink. The patient was treated with praziquantel and corticosteroids. Conclusion: Cerebral schistosomiasis due to Schistosoma mansoni is an uncommon presentation of schistosomiasis and can closely mimic a brain tumor. In endemic settings, it should be considered in the differential diagnosis of an intracranial mass when the epidemiological context is compatible. Histopathology provides definitive confirmation when tissue is obtained.

Mot-clés :

Schistosomiasis; brain; Schistosoma mansoni; Senegal