We fully agree that it would have been appropriate to treat the patient with praziquantel at the time the COPT was reported as positive. As noted, the test is quite specific and praziquantel therapy carries little risk. However, during the period in mid-1981 when the patient was acutely ill he was not under our care, and praziquantel was not generally available for use in the United States.
The interval of time between the end of the 10-week course of dexamethasone therapy and the normal CAT scan was only three weeks. From this one might infer that resolution of the cerebral lesions was accelerated by the dexamethasone therapy. However, since to our knowledge this is the only report which presents serial CAT scans of a patient with S. japonicum cerebritis, no comparisons can be made which would justify this inference.
The point that steroids should only be given as adjunctive therapy for patients with cerebral schistosomiasis and that specific treatment must be given merits reemphasizing.