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.
Here, we report a 48-year-old Egyptian male farmer who presented to our outpatient clinic with recurrent episodes of fresh bleeding per rectum. The patient had no local causes for rectal bleeding as confirmed by surgical consultation. The laboratory data were as follows: Hb 10.8 g/dL, serum albumin 4.2 g/dL, serum bilirubin 1 mg/dL, serum creatinine 0.9 mg/dL, and negative for hepatitis C virus antibodies. Pan-colonoscopy of the cecum showed a huge polypoidal mass of about 5 cm with broad pedicle 20 cm from the anal verge (Fig. ). Despite the suspicious malignant features of the mass, large size, broad base, eroded surface, and high vasculature, the histopathology showed small bilharzial granulomas (Fig. ), and the patient received a single dose of praziquantel. Six weeks later, a second colonoscopy was performed as the bleeding persisted. No noticeable change in size was observed. The second biopsy was confusing as it did not detect any bilharzial ova or malignancy and showed hyperplastic mucosa. Computed tomography (CT) examination demonstrated the luminal mass and showed circumferential wall thickening in the colon. On these findings, the probability of malignancy could not be excluded, so the patient was referred for surgical resection and anastomosis (Fig. ). The postoperative biopsy proved the pure bilharzial nature of the mass with both fresh and calcified ova.