PMC4078447_01
Preoperative MRI, revealing a hyperintense signal of the cord in the D4-D5 region, with a slight and diffuse thickening (Sagittal T2), cetromedullary (axial T2), showing a modest and diffuse enhancement with Gadolinium
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F1
The magnetic resonance imaging (MRI) documented a moderate and diffuse enlargement of medullary cord, in the D4-D5 region, with a central nonhomogeneous T2 hypersignal as well as heterogeneous enhancement after intravenous injection of gadolinium, with a granular pattern (disruption of the blood-brain barrier) [Figure 1].
Intraoperative imaging of the midline myelotomy revealing the grayish coal-like intramedullary tumor
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F2
Posterior midline myelotomy was performed using microsurgical dissection [Figure 2].
Immediate postoperative MRI, showing laminectomy of D3 to D5, with apparent gross total removal of the medullary granuloma (T1-weighed, sagittal, and axial)
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F3
H and E stain, showing numerous granulomata, enclosing parasites with the characteristic spicula of Schistossoma mansoni
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F4
The diagnosis of schistosomiasis was based solely on the demonstration of eggs and adult worm in the granuloma supplied for histopathology review [Figure 4], and later confirmed by positivity in serological tests hemagglutination, with all other work-ups inconclusive (no eggs found on stool or urine or rectal snipes, no eosinophilia in peripheral blood, no augmented VS).