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 14-year-old male student presented to our hospital with 5-week history of fever, rigors, cough and malaise for 1 month after returning from a visit to Albaha province (south of Saudi Arabia). He had been evaluated initially in a local hospital and diagnosed with community-acquired pneumonia. He received IV antibiotics and was discharged home on oral antibiotics.\nDuring hospitalization, he had an extensive work-up for fever of unknown etiology that included multiple blood cultures, urine analysis and culture, sputum for acid-fast bacilli (AFB), routine sputum cultures, serology for brucellosis, Monospot test and blood film for malaria. His clinical examination was unremarkable; complete blood count (CBC) and differential count, renal functions and serum electrolytes, chest X-ray and transthoracic echocardiogram were all unremarkable. His liver profile was mildly deranged with aspartate aminotransferase (AST) activity of 48 U/L and alanine aminotransferase (ALT) activity of 82 U/L. He was discharged home and given outpatient appointment for follow-up.\nHe was re-admitted again 16 days later because of persistence of his symptoms. His clinical examination was also unremarkable. His laboratory investigations, however, were as follows: WBC count 8.1×109/L (eosinophils 30%; lymphocytes 35%; monocytes 7%; neutrophils 25%; and bands 3%), Hb=121 g/L, and platelets 438×109/L)\nHis chest X-ray showed ill-defined infiltrate. Thus, a chest computed tomography (CT) was requested and revealed peripheral nodular and patchy infiltrates in both lung fields []. There was evidence of splenomegaly in the lower cuts of the scan.\nRepeated CBC and differential count was significant for increasing peripheral blood eosinophil count to 63%, with an absolute count of 9.4×109/L and WBC of 14.9×109/L. Blood, urine, sputum cultures and sputum for AFB were negative. Two stool samples for microscopy were negative for parasite. Serum IgE level was 334 U/L, (normal <200 U/L), ANCA-P test was negative, and renal functions and liver function tests were unremarkable.\nBronchoscopy was performed. Bronchoscopic alveolar lavage (BAL) fluid analysis showed marginally elevated eosinophils (7%); however, microbial studies (including AFB, fungal and routine bacterial cultures) were negative. A transbronchial biopsy showed tissue eosinophilia.\nThe patient underwent video-assisted thoracoscopic lung biopsies from the left lower lobe which showed a schistosomal ovum within a well-formed granuloma []. Subsequently, the test for schistosoma antibodies serology came positive. The diagnosis of acute pulmonary schistosomiasis was then made.\nThe patient was given praziquantel (20 mg/kg body weight) twice daily for 2 days. Two days later, he reported to our emergency department with high-grade fever and rigors. His symptoms subsided with the addition of a short course of prednisolone. After this, he visited our outpatient clinic for follow-up and was free of symptoms and had a normal chest X-ray.