Case Report
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World J Gastroenterol. Nov 28, 2005; 11(44): 7044-7047
Published online Nov 28, 2005. doi: 10.3748/wjg.v11.i44.7044
A case of bowel schistosomiasis not adhering to endoscopic findings
Manfredi Rizzo, Pasquale Mansueto, Daniela Cabibi, Elisabetta Barresi, Kaspar Berneis, Mario Affronti, Gabriele Di Lorenzo, Sergio Vigneri, Giovam Battista Rini
Manfredi Rizzo, Pasquale Mansueto, Mario Affronti, Gabriele Di Lorenzo, Sergio Vigneri, Giovam Battista Rini, Department of Clinical Medicine and Emerging Diseases, University of Palermo, Italy
Daniela Cabibi, Elisabetta Barresi, Institute of Pathological Anatomy, University of Palermo, Italy
Kaspar Berneis, Medical University Clinic, Bruderholz, Switzerland
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr Manfredi Rizzo, Dipartimento di Medicina Clinica e delle Patologie Emergenti, Universita’ di Palermo, Via del Vespro, 141, 90127 Palermo, Italy.
Telephone: +39-091-6552945 Fax: +39-091-6552945
Received: April 3, 2005
Revised: May 1, 2005
Accepted: May 3, 2005
Published online: November 28, 2005

Schistosomiasis is a chronic worm infection caused by a species of trematodes, the Schistosomes. We may distinguish a urinary form from Schistosomes haematobium and an intestinal-hepatosplenic form mainly from Schistosomes mansoni characterized by nausea, meteorism, abdominal pain, bloody diarrhea, rectal tenesmus, and hepatosplenomegaly. These infections represent a major health issue in Africa, Asia, and South America, but recently S mansoni has increased its prevalence in other continents, such as Europe and North America, due to international travelers and immigrants, with several diagnostic and prevention problems. We report a case of a 24-year-old patient without HIV infection, originated from Ghana, admitted for an afebrile dysenteric syndrome. All microbiologic studies were negative and colonoscopy revealed macroscopic lesions suggestive of a bowel inflammatory chronic disease. Since symptoms became worse, a therapy with mesalazine (2 g/d) was started, depending on the results of a bowel biopsy, but without any resolution. The therapy was stopped after 2 wk when the following result was available: a diagnosis of “intestinal schistosomiasis” was done (two Schistosoma eggs were detected in the colonic mucosa) and this was confirmed by the detection of Schistosoma eggs in the feces. Therapy was therefore changed to praziquantel (40 mg/kg, single dose), a specific anti-parasitic agent, with complete recovery. Schistosomiasis shows some peculiar difficulties in terms of differential diagnosis from the bowel inflammatory chronic disease, as the two disorders may show similar colonoscopic patterns. Since this infection has recently increased its prevalence worldwide, it has to be considered in the differential diagnosis of our patients with gastrointestinal symptoms.

Keywords: Schistosomiasis, Chronic inflammatory bowel disease, Ulcerative colitis, Granuloma