Conus medullaris neuroschistosomiasis mimicking Guillain-Barre syndrome: A case of delayed diagnosis leading to permanent neurological damage.

Key Clinical Message: In the evaluation of acute flaccid paralysis, particularly in pediatric populations within endemic areas for schistosomiasis infection, clinicians must maintain a high index of suspicion for neuroschistosomiasis. Prompt identification is imperative to mitigate the risk of irreversible neurological sequelae.

Abstract: Spinal cord involvement in neuroschistosomiasis (NS) is considerably rare, with even fewer reported cases affecting the conus medullaris in children. While NS's neurological sequelae are typically thought to be reversible, delayed diagnosis and treatment can lead to permanent deficits. We report a case of a 9-year-old boy who presented with 3 weeks of progressive bilateral lower extremity weakness. A spinal MRI showed patchy gadolinium enhancement in an expanded conus medullaris, leading to a presumed diagnosis of Guillain-Barre syndrome, and the patient was treated with intravenous immunoglobulin. However, the lack of improvement necessitated surgical laminectomy. The post-operative histopathological examination confirmed the presence of a schistosomal parasite. Despite initiating therapy with corticosteroid and praziquantel, the patient did not exhibit clinical improvement, resulting in persistent flaccid paralysis, bladder, and bowel incontinence. In conclusion, spinal NS should be considered in patients presenting with myeloradicular symptoms in regions endemic for schistosomal infection, as delayed recognition can result in irreversible outcomes.