S3527 Hepatic and Gastrointestinal Complications of Chronic Schistosomiasis: A Case Report on the Importance of Treatment Confirmation

Abstract

INTRODUCTION: Schistosomiasis affects millions worldwide and can have devastating hepatosplenic and intestinal consequences. Though it is well-known to providers in tropical and subtropical parts of the world, those in non-endemic areas are often unfamiliar with the disease and its complications. CASE DESCRIPTION/METHODS: A 76-year-old Filipino female with a history of schistosomiasis complicated by portal hypertension presented to a tertiary care center for shortness of breath. In the emergency department, she was found to be hypoxic with increased work of breathing. Chest x-ray demonstrated a recurrent hepatic hydrothorax that required emergent thoracentesis. On admission, she reported subacute on chronic abdominal pain previously attributed to symptomatic cholelithiasis. Physical exam was notable for tachycardia to the 120s and a mildly, diffusely tender abdomen. Relevant laboratory tests included: white blood cell count 11,200/mm3 without eosinophilia, AST 44 U/L, ALT 21 U/L, alkaline phosphatase 172 IU/L, total bilirubin 1.2 mg/dL, and direct bilirubin 0.4 mg/dL. Imaging studies revealed a chronic portal vein thrombus (PVT), a 20–30 cm loop of severely thickened distal ileum, multiple inferior mesenteric arteriovenous malformations (AVMs), calcifications in the sigmoid colon, and cholelithiasis. Review of prior records showed that when she was 48 years old, the patient had a liver biopsy with Schistosoma japonicum ova in the portal tracts. Despite this, she never received treatment for schistosomiasis. After diagnosis, she had seen multiple providers in various specialties (hepatology, surgery, primary care) at different institutions. It was always assumed that she had been treated. This patient’s initial management included praziquantel, inferior mesenteric AVM embolization, prophylactic enoxaparin for PVT, a percutaneous cholecystostomy tube for symptomatic cholelithiasis, and diuresis for hepatic hydrothorax. She was admitted twice more within a month of discharge due to further complications of her disease. Ultimately, she was discharged with home hospice care. DISCUSSION: This case demonstrates the importance of confirming schistosomiasis treatment in previously diagnosed patients. This patient had seen multiple specialists prior to a provider realizing she had never received treatment. Ultimately, the complications of chronic schistosomiasis became life-limiting but may have been prevented if treatment had occurred at the time of diagnosis.