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.
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.