The role of corticosteroids in the treatment of cerebral schistosomiasis caused by Schistosoma mansoni: Case report and discussion

A 26-year-old Brazilian man was admitted to The Toronto Hospital with a hea dache and visual scintillation. His last travel to Brazil was five years pr eviously. A computed tomography (CT) scan of the head showed an occipital m ass with surrounding vasogenic edema. Occipital brain biopsy revealed Schis tosoma mansoni eggs. The patient was treated with two doses of praziquantel (20 mg/kg) and dexamethasone (10 mg). His symptoms and occipital mass reso lved. Cerebral schistosomiasis is, in part, caused by the host's inflammato ry response to Schistosoma. Modes of treatment have included surgical resec tion, the antiparasitic drugs oxamniquine or praziquantel, and corticostero ids. Corticosteroids may diminish granulomatous inflammation, thereby preve nting further tissue destruction, and there is evidence that they also redu ce ova deposition. Our review of the literature supports prompt medical the rapy in patients with cerebral schistosomiasis. While the minimally or asym ptomatic individual may be treated with praziquantel alone, clinicians shou ld consider adjunctive therapy with corticosteroids for patients with promi nent neurologic signs or symptoms or mass lesions with evidence of surround ing edema on a CT scan or by magnetic resonance imaging.