A 60-year-old healthy asymptomatic female underwent screening colonoscopy with findings of yellowish rectal subepithelial nodules (measuring up to 5 mm in diameter) (). The patient was referred for endoscopic ultrasound. The patient lived in an endemic area for schistosomiasis in Brazil and had a positive history of freshwater bathing.\nEndoscopic examination was performed under sedation and monitored by an anesthesiologist. A multifrequency radial endoscope was used. Ultrasound revealed the presence of deep mucosal nodular lesions with calcified/hyperechoic inclusions (). There were no alterations in the deeper colonic wall layers. A diagnosis of schistosomal granulomas was considered and biopsies were performed.\nHistologic analysis revealed fragments of colonic mucosa showing increased cellularity in the lamina propria, with mononuclear inflammatory infiltrate and lymphoid follicles. In addition, granulomas in the healing phase were noted with hyaline fibrosis and calcified areas of Schistosoma mansoni. There were no viable eggs noted in the histologic evaluation. The final diagnosis was chronic schistosomal colitis (). The patient was treated with praziquantel (40 mg/kg body weight).
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.