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).
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​​​​​​​