SCHISTOSOMA COLITIS

Abstract

Schistosomiasis is a major source of morbidity and mortality for developing countries in Africa, South America, the Caribbean, the Middle East, and Asia. Tourism and immigration result in schistosomiasis cases presenting in the developed world. It is a human disease syndrome caused by infection from one of several species of parasitic trematodes of the genus Schistosoma. The adult flukes lay large numbers of eggs in the walls of the intestines or bladder, some of which flow through the bloodstream to the liver eliciting an inflammatory response in those regions. We present a case of Schistosoma Colitis which is uncommonly seen in the United States. A 48 year-old male, an immigrant from Brazil, presented with 4 days of severe, intermittent cramping abdominal pain located in the epigastrium and left-lower quadrant. It was associated with nausea, subjective fevers and intermittent non-bloody watery diarrhea. On examination, he was febrile to 100.1F, tachycardic at 102 beat per minute, and tachypneic at 24 breaths per minute. His blood pressure was 111/67. He had epigastric and left-lower quadrant tendernes with presence of guarding but no rebound tenderness. He had no rectal mass palpable and was guaiac negative. Laboratory data on presentation revealed WBC of 12.2 TH/UL with 10.4% eosinophils. CT scan of the abdomen and pelvis showed wall thickening throughout the colon with sparing of the sigmoid. The patient was initially treated with intravenous Flagyl, ampicillin and gentamicin. The stool studies including fecal leucocytes, C. difficile, ova and parasites were normal. Colonoscopy revealed mild edema and patchy erythema throughout the colon. Random biopsies from the colon showed moderately active, chronic colitis with reactive glandular atypia. Schistosome eggs were present in the mucosa. Rectal biopsy revealed similar findings. The patient was then started on Praziquantel 1200 mg QID for 3 days with good response. Schistosoma colitis is an unsual etiology of abdominal pain in the nonendemic areas. It is estimated that 400,000 immigrants from endemic regions may harbor the infection. Exposure to schistosomiasis is a health hazard for U.S. citizens who travel to endemic areas. Hence, we need to be aware of it in our differential when evaluating patients with abdominal pain who are from or have recently travelled to an endemic area.