A 35-year-old woman presented to the gastroenterology clinic for evaluation of dull abdominal pain. The abdominal pain started insidiously 2 years previous, was intermittent in nature, and located in the epigastric and left lower quadrant. The patient also complained of concomitant diarrhea, flatulence, and bloating. She denied melena, hematochezia, nausea, vomiting, fevers, chills, or weight loss. She had an upper endoscopy and colonoscopy 2 years earlier with no significant findings. She had a medical history notable for type 1 diabetes mellitus and a previous benign bladder tumor with unknown pathology that was surgically resected. She was born and raised in the United States and had lived in multiple cities within the United States. Her only travel outside of the United States had been during her childhood on vacation to the Bahamas, the Cayman Islands, and Mexico. She denied any wading or swimming in any freshwater source outside of the United States. She denied any cigarette smoking, alcohol use, or illicit drug use.\nHer abdominal examination revealed no distention, no scars, normal bowel sounds, no tenderness, no organomegaly, and normal tympani. The rest of her physical examination was unremarkable. Her laboratory testing was within normal limits. Abdominal ultrasound was performed at a later time due to abdominal pain showed a 9-mm indeterminate hepatic lesion. Abdominal magnetic resonance with and without contrast showed multiple hyperenhancing liver lesions. The hepatic lesions were biopsied. It revealed non-necrotizing granulomas composed of multinucleated giant cells and cuffs of lymphocytes; moderate hepatic steatosis was present.\nUpper endoscopy was performed to reveal a 40-mm pedunculated polyp with no bleeding in the second part of the duodenum; this was resected (Figure ). The esophagus and stomach were normal. Colonoscopy revealed a 6-mm sessile polyp in the sigmoid colon; this was resected. Pathology from the duodenal polyp revealed adenomatous changes arising in a hamartomatous polyp (Peutz-Jeghers type); there was also the presence of parasite organisms present in the crypts of the polyp consistent with schistosomiasis with tissue eosinophilia (Figure ). Pathology of the colon polyp revealed hyperplastic changes. The patient was diagnosed with a hamartomatous duodenal polyp due to Schistosoma mansoni. The patient was referred to infectious disease. She was prescribed praziquantel 20 mg/kg/dose 3 times per day for 1 day. The patient followed up with gastroenterology after treatment with praziquantel. Her diarrhea had resolved, but she continued to have intermittent left lower quadrant abdominal pain, attributed to irritable bowel syndrome. Repeat endoscopy showed no evidence of duodenal hamartomatous polyp.
A 24-year-old Yemeni male without any previous medical history presented to the emergency department complaining of sudden right-sided chest pain with shortness of breath after taking a shower earlier the same day. Upon questioning, there was no history of trauma, cough, recent travel to potentially endemic areas, recent infection, or any previous similar symptoms. Regarding his vital signs, he was afebrile with a heart rate of 78, respiratory rate of 20, blood pressure of 124/65 mmHg, and oxygen saturation of 96%. He was well-oriented and alert but showed signs of respiratory distress and difficulty in respiration. His chest examination revealed decreased air entry on the right side and normal breathing on the left side. Meanwhile, his other systemic examinations were unremarkable. His investigational panel included complete blood count (CBC) with differential was within normal limits except for isolated eosinophilia. Furthermore, electrolytes and cardiac markers were normal while tuberculosis acid bacilli were negative and blood culture showed no growth. Later, a chest X-ray (CXR) showed right-sided pneumothorax and a collapsed lung (Figure ) with no mediastinal shift. Therefore, the patient was admitted, and a chest tube was inserted accordingly.\nThe following day, a persistent air leak was noted in the chest tube without resolution of the pneumothorax, which raised the suspicion of the presence of a fistula. The following day, the patient underwent bullectomy, pleurectomy, and pleural abrasion via a video-assisted thoracoscopic surgery (VATS). The patient continuous leak was resolved, and there were no signs of an active leak in the following 24 hours. The resected wedge weighed 3 g and measured 3.5 x 2.0 x 1.0 cm. Histopathology cross-section of the specimen was stained with hematoxylin and eosin (H&E) stain showing signs of schistosomiasis eggs of Schistosoma mansoni (Figure ) and was discharged on praziquantel with a follow-up appointment. The patient then failed to follow up further.