Ectopic Cutaneous Schistosomiasis: Report of Two Cases and a Review of the Literature

Abstract

Two cases of ectopic cutaneous schistosomiasis are described. Both patients presented with abdominal papular skin lesions, which on biopsy were found to contain granulomas with Schistosoma mansoni eggs. Twenty-five other cases were retrieved from the literature. Most patients were female, mean age 24.9 year, with a predominance of the white race. The most common localization was anterior thorax and abdomen. Usually, the lesions were asymptomatic. In few cases, however, severe clinical syndromes due to the parasite coexisted, such as transverse myelitis or the acute-toxemic form of the disease. Intestinal infection was not frequently demonstrated in these patients. The importance of the recognition of these cutaneous lesions may rest on the opportunity to provide an etiological diagnosis in these difficult cases.

Cutaneous schistosomiasis: Case report and literature review

“…While our patient presented with lesions on the neck and posterior trunk, similar to the case reported by van Dijk [8] and Andrade Filho, [5] in a review of cases seen in about three decades from different regions of the world, it was documented that the anterior trunk was the site of predilection, with 14 of 25 cases found at this site, and only four in the neck region; yet any part of the body may be affected, including the anogenital skin. [6] The presence of anastomoses of porto-systemic vessels on the trunk with pelvic vessels may explain this association.…”

“…[7] However, review of reports by Obasi [4] from Nigeria, Andrade Filho [5] from Brazil, and Leman [6] from the United Kingdom among others has shown papular presentation to be the predominant pattern, and similar to our index case, tends to appear in crops.…”

“…[6] Epidemiologically male preponderance and highest frequency in the second to third decades of life have been noted for cutaneous presentation of the disease. [5] These age and gender patterns, reflected in our index case, highlight the social risk factors at play whereby young adult males in our area visit bodies of water which may harbor Bulinus, the parasite vector, either for leisure or fishing.…”

“…The fertilized ova may also be carried in Similar to this patient being presented, the skin lesions may also appear several months to years after the initial infection [5,9] such that clinical history may not be very helpful. This may be the most important diagnostic challenge one is faced with when confronted clinically with such an uncommon lesion.…”

“…[2,3] Obasi, [4] in Zaria, northwestern Nigeria, following literature review, identified eight cases of cutaneous schistosomiasis over a 40-year period with risk factors being travel to countries endemic for schistosomiasis as well as living in countries holo-/hyper-endemic for the disease. [4,5] This case report aims to highlight the clinical presentation of ectopic cutaneous schistosomiasis, challenges in its diagnosis, and emphasize the role of histology in its diagnosis.…”