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​​​​​​​
A 67-year-old woman from the Philippines with a medical history of psoriatic arthritis, hypertension, osteoporosis, and resected left-sided invasive ductal carcinoma of the breast presented with complaints of chronic lower abdominal discomfort associated with constipation alternating with diarrhea for a year, along with decreased appetite and 20 lbs. weight loss. She denied fever, bright red blood per rectum, or melena. She migrated to the United States from the Philippines in 1998. She never had a colonoscopy in the past. Her family history was negative for cancer. Vital signs and physical examination were unremarkable. Laboratory tests were noncontributory other than normocytic anemia with hemoglobin of 11.6 g per deciliter, no eosinophilia.\nSubsequent colonoscopy revealed a malignant appearing obstructing mass in the distal sigmoid, around 20 cm from the entry site (Figure ). Biopsies from the mass revealed fragments of adenocarcinoma. Pelvic computed tomography (CT) revealed bladder wall thickening (Figure ). Thoracic and abdominal CT revealed no distant metastasis. She underwent successful anterior pelvic exenteration, sigmoid resection with primary anastomosis, and ileal conduit creation for sigmoid cancer invading the bladder. Surgical pathology showed invasive, moderately differentiated adenocarcinoma in the sigmoid colon and numerous Schistosoma eggs in the colon, ovaries, posterior cul de sac, and pelvic wall (Figure ). Along with surgical treatment, the patient was treated with praziquantel (60 mg/kg/d in 2 divided doses). Stool microscopic examination after 4 weeks of treatment was negative for ova and parasites.