The phenomenon may be seen in MRI as multiple focal lesions with a linear or spotty appearance following gadolinium enhancement.6 Similar cases of acute neuroschistosomiasis at the time of larval invasion have been reported previously, and show close radiological abnormalities to those identified here.7–9 Furthermore, Akt inhibitor the two cases presented herein were brothers with a common genetic

background, and they were considered to have been infected simultaneously with the same pathogen. They showed a close form of inflammatory, poly-symptomatic encephalitis and were identically managed by initial administration of praziquantel with apparent rapid resolution of most systemic symptoms and of neurological involvement as well. Remaining or secondary symptoms accounting for pyramidal signs with tremor or gait disturbance were improved with a rapid resolution following a second administration of praziquantel and the initiation of corticosteroid treatment. This observation is in-line with standard care of acute neuroschistosomiasis10 considering the option challenge with high doses of corticosteroids as soon as possible to attenuate or avoid cerebral vasculitis.10,11 Thus, the first dose of praziquantel

should be given when neurological symptoms have abated, to prevent worsening of central inflammation through larval lysis.11,12 A second dose of praziquantel should be given routinely a few weeks after the first dose, as praziquantel is only effective against fully grown worms. ADEM associated with S mansoni larval invasion has been documented infrequently. Public health Belnacasan campaigns aimed at traveler education and increasing awareness of these risks are thus of prime importance. The physician should be alerted by the presence of neurological symptoms in patients presenting with Katayama fever to perform an MRI and initiate corticosteroid treatment if necessary to avoid aggravation. We thank Dr A. Doble for the generous help and proof reading. The authors state they

have no conflicts of interest to declare. “
“Old World mucosal leishmaniasis is a rare but regularly reported disease in Southern Europe. We report the case of a 64-year-old woman who developed severe hypokalemia under meglumine antimoniate treatment and was successfully Isotretinoin treated under second line therapy with miltefosine. A 64-year-old Swiss woman was referred by her dentist with therapy-refractory painful mucosal lesions in the oral cavity, persisting over the last 6 months. The dental examination revealed multiple mucosal lesions on the hard and soft palate, gingiva, and base of the tongue, with the largest lesion measuring about 15 mm in diameter (Figure 1). Past medical history and physical examination were otherwise unremarkable revealing no history of skin lesions. Routine laboratory investigations—including tests for underlying immunodeficiency—were inconspicuous.