Parasitic Egg Consistent With Schistosoma on Rectosigmoid Biopsy

Abstract

A 39 years-old Ethiopian male presented with complaints of changes in bowel habits, diarrhea, and rectal pain of less than one month. He denied any previous episodes and does not have any past medical history. He states that he does not take any medications, and has not changed his diet in the past month. His history is significant for recent immigration to the United States. The patient was referred to a gastroenterologist for an elective outpatient colonscopy and esophagogastroduodenoscopy. The patient's initial complete blood count demonstrated mildly elevated eosinophil percentage (7.2%) and a slightly elevated mean corpuscular hemoglobin (33.1 pg). His basic metabolic panel was within normal limits. The coagulation profile demonstrated a decreased international normalized ratio (0.93). Findings on colonscopy demonstrated a normal appearing terminal ileum; however, mild colitis in the rectosigmoid junction [Figure 1] and rectum. The mucosa was erythematous and edematous. Three cold forcep biopsies were taken [Figures 2, 3]. There were also three polyps measuring less than 5mm in size found in the rectosigmoid junction. Furthermore, there were two polyps measuring 5 and 3 mm found in the rectum. Both were completely removed by cold snare polypectomy. Internal hemorrhoids were also noted. Then the patient had an esophagogastroduodenoscopy. There were moderately erythematous mucosa found in the antrum, body, and fundus of stomach. Four biopsies were taken. There were also evidence of duodenitis in the duodenal bulb and the second portion of the duodendum.Figure 1Figure 2The patient was instructed to follow-up in two weeks for biopsy results, start a high fiber diet, and avoid non-steroidal anti-inflammatory drugs. Biopsy results from the rectosigmoid showed a parasitic egg consistent with Schistosoma species [figure 3], patchy acute and chronic inflammation with mucosal eosinophilia. The polyps biopsied in both the rectosigmoid junction and rectum were consistent with hyperplasia. While biopsy results from the gastric biopsies were consistent with chronic active gastritis, with immunostain for H. pylori being positive. Slides from specimens were reviewed for quality assurance and consensus regarding diagnosis of parasitic egg consistent with Schistosoma species.Figure 3The patient was treated with praziquantel. He will follow up in 6 months for antigen testing of stool and urine for excreting eggs and direct assays for eggs in stool and urine via microscopy. He instructed to return sooner if symptoms recur.