We report a 63-year-old Asian female with no significant past medical history, who presented to our clinic reporting an eight-week history of abdominal pain, anorexia, and weight loss. The abdominal pain was mild to moderate, crampy in nature and generalized. It was aggravated with food intake and partially relieved with proton pump inhibitors and probiotics. It was associated with nausea, bloating and an unintentional weight loss of five kilograms in six months. She denied any fever, skin rash, chronic diarrhea or rectal bleeding. She reported traveling back and forth from Hawaii to the Philippines many times before she moved to Florida one year prior. Her physical examination was unremarkable. Her complete blood count and metabolic profile were unremarkable except for a borderline normocytic anemia (hemoglobin at 11.7g/dL). Urine analysis and routine ova and parasites exams in both urine and stool were negative. Right upper quadrant ultrasound was unrevealing. Esophagogastroduodenoscopy (EGD) was unremarkable, as shown in Figure , while colonoscopy showed a 10 milimeter (mm) flat polyp in the descending colon which underwent endoscopic mucosal resection (EMR). Pathology showed hyperplastic colon mucosa with numerous parasite eggs deposition in the submucosa, consistent with Schistosoma species (Figure ). The patient was then treated with Praziquantel (1800 mg in divided doses for one day) and her symptoms, including abdominal pain and bloating, were reported to improve. She also started to gain weight as noted in the two-week follow up visit.\n​​​​​​​
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.