We read with great interest the case report of a patient having Schistosoma japonicum cerebritis and resolution of CAT brain scan abnormalities without specific antiparasitic therapy. We are currently studying the chronic form of the disease in the Philippines, as opposed to the acute “Katayama fever” case described. This fascinating report brought to mind several questions and comments.
At the time the initial abnormalities on CAT scan were seen, there was no documentation that the patient had schistosomiasis. Both multiple stool examinations and rectal biopsy were initially unsuccessful in demonstrating schistosome ova, although as the authors point out, eggs might have been missed. By the time later tests confirmed the diagnosis, the CAT scan lesions had resolved. Thus it is very likely that the initial scanning abnormalities were caused by schistosomiasis, but not definite.
About 6 weeks after the onset of symptoms, the patient had a positive circumoval precipitation test (COPT).