First documented case of solitary cerebellar Schistosoma japonicum neuroschistosomiasis confirmed by real-time polymerase chain reaction of the lesion: illustrative case.

backgroundNeuroschistosomiasis is a rare manifestation of Schistosoma infection, typically affecting the spinal cord and supratentorial brain regions. Cerebellar involvement is exceedingly uncommon and often presents with multiple enhancing lesions on imaging, mimicking neoplastic processes. Solitary cerebellar lesions are even more unusual. The authors present the first reported case of solitary cerebellar neuroschistosomiasis confirmed via real-time polymerase chain reaction (RT-PCR) on brain tissue caused by Schistosoma japonicum. OBSERVATIONS: A 33-year-old man from an endemic region presented with a 3-month history of progressive headache, vomiting, and imbalance. Imaging showed a solitary right cerebellar lesion with obstructive hydrocephalus. A ventriculoperitoneal shunt was placed, followed by tumor resection. Intraoperative and histopathological findings revealed schistosomal ova. RT-PCR on formalin-fixed paraffin-embedded tissue confirmed S. japonicum. The patient was treated with praziquantel and dexamethasone and remained asymptomatic at the 6-month follow-up. Unlike previous reports, this case involved a solitary lesion and a prolonged symptom course, with RT-PCR confirming the diagnosis directly from brain tissue. LESSONS: Solitary cerebellar neuroschistosomiasis can mimic tumors and should be considered in endemic areas. RT-PCR on brain tissue offers a valuable diagnostic tool. Timely surgical and medical management can lead to full recovery, emphasizing the importance of considering parasitic infections in atypical intracranial lesions. https://thejns.org/doi/10.3171/CASE25282.