Abstract
Background: To present a case of simultaneous infection with two types of schistosoma. To underline the role of colonoscopy in diagnosis. Methods: A 30 year old Mauritian male was admitted to the Nephrology department as he had been recently diagnosed with hypertension due to chronic renal failure. Basic laboratory tests revealed leucocytosis (13,100 WBC/μL), eosinophilia (5,100/μL), elevated IgE 1050 UI/ml. The patient mentioned having constipation and periodic diffuse abdominal pain. The upper abdominal ultrasound showed increased echogenicity of both kidneys. C/T scan demonstrated bilateral nodular lesions <1 cm. Bone marrow aspiration was non diagnostic. The patient finally underwent urinary bladder cystoscopy that was normal and 24 hour urine collection showing no ova. Renal biopsy was not performed due to increased risk of complications. Inspite of these results, it was decided that a total colonoscopy with squash preparations and biopsies was needed. Results: Colonoscopy showed terminal eileum having normal appearence, transverse colon having 2-3 mucosal folds with whitish nodules interlaping with normal mucosa and finally rectosigmoid being erythematous, with small ulcers which were friable and again whitish nodules surrounded by normal mucosa. Biopsy was performed the result of which showed schistosomal ova in different phases of necrosis (rectosigmoid), chronic eosinophilia and inflammation (right and transverse colon). Squash preparations taken during colonoscopy were examined under the microscope: the samples from rectum and sigmoid showed multiple granulomas around S. intercalatum ova and the samples from transverse colon showed a few granulomas around S. intercalatum ova. The patient received 2 courses of treatment with praziquantel. Because his symptoms as well eosinophilia were still present after the treatment, it was decided to give a a 3rd course. Follow-up colonoscopy 10 days later showed normal colonic mucosa. Eosinophilia and symptoms regressed. Conclusion: Diagnosing enteric Schistosomiasis is difficult because stool samples are often negative. At times were parasitic infection is strongly suspected, total colonoscopy and squash preparations may be needed to establish the diagnosis. Abstracts for SupplementInternational Journal of Infectious DiseasesVol. 14Preview Full-Text PDF Open Archive
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