Acute neuroschistosomiasis: a cerebral vasculitis to treat with corticosteroids not praziquantel.

摘要

We read with interest the article by Houdon and colleagues reporting two patients with imported acute neuroschistosmiasis due to Schistosoma mansoni. Both patients presented with neurological signs revealing acute schistosomiasis (AS), and the diagnosis of acute disseminated encephalomyelitis (ADEM) was raised to explain these symptoms. However, the diagnosis of eosinophilia-induced cerebral vasculitis appears to be more likely than that of ADEM for many reasons: patient's histories (which started with neurological signs), clinical presentation (association with other signs), high eosinophilia (1900 and 2100/mm, respectively), and the brain magnetic resonance imaging aspects (suggesting border zone infarcts). Indeed, ADEM is considered as a postinfectious disorder because it is usually preceded (7-14 days, 2 days to 4 weeks, according to the authors) by a febrile episode (or an antigenic challenge), most commonly related to a viral or bacterial infection (mostly nonspecific upper respiratory tract infection) or sometimes a vaccination.