Abstract
Schistosomiasis is a parasitic disease which is the third most devastating tropical disease in the world. It is rarely seen in the USA and can present in an acute or chronic, indolent fashion. This clinical vignette will highlight the presentation, diagnosis and treatment of chronic intestinal schistosomiasis.This is a case of a 72 year-old Philippine retired nurse with unremarkable medical history who presented for her routine screening colonoscopy. Examination was unremarkable, and her lab tests were normal. Colonoscopy showed multiple 2-4 mm sessile polyps in the rectum. Histology showed deep mucosal and submucosal calcified ova with cuticle, consistent with Schistosoma ova. Stool microscopy was negative for ova and parasite. She was treated with Praziquantel and scheduled for follow up colonoscopy. On further questioning, she moved to the US at 45 and had no previous history of infection. But, she did recall bathing in freshwater.Schistosomiasis is a tropical disease caused by Schistosoma organism. Worldwide it is estimated that there are over 200 million cases, 90% being in Africa. Infections are rare in the US, and cases are often encountered among veterans or immigrants. Five species are known to cause infections; all infest the mesenteric and portal veins except for S. haematobium which mainly involves the bladder and rectum. The symptoms of schistosomiasis are non-specific and may mimic other GI diseases. Patients might be asymptomatic as in our case, and the parasite can survive and replicate in human hosts for years, even decades. Diagnosis is often made by stool, urine or serologic samples to evaluate for the eggs.Urine and blood can show increased eosinophils. Endoscopic findings include mucosal edema, congestion with petechial hemorrhage, inflammatory polyps with granularity, ulceration or hemorrhage. Characteristically there are grayish yellow schistosomal nodules similar to those of pseudomembranous colitis. Chronic cases may appear as elevated yellow nodules, polyps and strictures. Histologically, the inflammatory polyps and ulcers show prominent eosinophilic infiltrate and granulomas around the ova. As the lesions progress, fibrosis becomes more apparent. Praziquantel is the gold standard, and follow up after treatment is via resolution of symptoms, eosinophilia or eggs/ova in stool/urine. In our case, the use of steroids was not indicated due to its chronicity. Our case required repeat colonoscopy to visualise direct resolution of polyps.Figure 1Figure 2Figure 3
Published Version
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