PMC9519849_01
Initial MRI. (A) Axial MRI without contrast showing a hypointense signal on T1-weighted images in the right brainstem. (B) Intermediate signal on T2-weighted image surrounded by hyperintense signal of brain edema.
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T1-weighted without contrast images revealed a hypointense mass lesion in the right brainstem (Figure 1A). T2-weighted images showed an intermediate signal with irregular and poorly defined borders, surrounded by the hyperintense signal of edema (Figure 1B).
Colonoscopy imaging. (A) Yellow plaque formation under the enteric mucosa with an unclear blood vessel network, indicating a specific inflammatory response to Schistosoma eggs. (B) Photomicrograph of histologic section showing calcified Schistosoma japonicum eggs in the lamina propria of the rectum (hematoxylin-eosin staining, objective x200).
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An electronic colonoscopy showed a specific inflammatory response to the Schistosoma eggs (Figure 2A). The following mucosal biopsy confirmed the presence of S. japonicum eggs in the lamina propria of the rectum (Figure 2B).
(A-C) MRI at admission: Axial, sagittal, and coronal T1-weighted, enhanced images showing significant, patchy, marked-enhancement lesions in the right brainstem after intravenous gadolinium administration. (D-F) Post-treatment MRI at the 4-month follow-up: T1-weighted enhanced images showing regressive lesions in the brainstem.
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A non-specific tumor-like lesion that was surrounded by edema and associated with mass effect and heterogeneous contrast enhancement was revealed (Figures 3A-C). At the 4-month follow-up, the patient's symptoms had completely resolved, and a repeat cerebral MRI showed dramatic regression of the contrast enhancement in the brainstem (Figures 3D-F).