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Unusual presentation of more common disease/injury
CASE REPORT
Hepatosplenic schistosomiasis: playing hide-and-seek with an elusive parasite
  1. Martin Baekby1,
  2. Henning Glerup2,
  3. Katrine Stribolt3,
  4. Britta Tarp2
  1. 1Department of Clinical Microbiology, Aarhus Universitetshospital, Aarhus N, Denmark
  2. 2Department of Internal Medicine, Regionshospitalet Silkeborg, Silkeborg, Denmark
  3. 3Department of Pathology, Regionshospitalet Randers, Randers, Midtjylland, Denmark
  1. Correspondence to Dr Britta Tarp, brittarp{at}rm.dk

Summary

A 27-year-old man of Eritrean origin presented with persistent left-sided abdominal pain. Initial investigation showed signs of liver fibrosis, portal hypertension and splenomegaly. A diagnosis of hepatosplenic schistosomiasis was suspected on grounds of elevated total IgE, grey area antischistosomiasis antibodies and the high endemic status of his native country. However, repeated microscopy of faecal and urine samples, as well as rectal biopsies, failed to demonstrate schistosomal eggs. Finally, the diagnosis of hepatosplenic schistosomiasis was established through demonstration of a Schistosoma mansoni egg in a liver biopsy taken in an attempt to clarify the cause of the above findings. The patient had recently been treated for uncomplicated malaria. Lowered schistosomiasis worm/egg burden and hence reduced sensitivity of classic microscopy-based schistosomiasis testing was attributed to the antischistosomal activity of the antimalarial chemotherapy.

  • infection(gastroenterology)
  • cirrhosis
  • hepatitis and other Gi infections
  • tropical medicine (infectious Disease)
  • portal hypertension

https://doi.org/10.1136/bcr-2017-219437

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    Footnotes

    • Contributors Senior House Officer MB prepared the manuscript and made corrections as suggested by the other authors. Consultant HG revised the manuscript critically and supplied pictures from the small bowel capsular endoscopy. He also wrote the caption for figure 3. Consultant KS revised the manuscript critically and supplied pictures from the liver biopsy (figure 1). Consultant BT was in charge for the investigation and treatment. She revised the manuscript critically. All authors approved the final version.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.