Ectopic cutaneous schistosomiasis - Case report

Abstract

Schistosomiasis is best known in its visceral form but it can attack the skin, its ectopic cutaneous manifestation being rare and clinically difficult to diagnose. It is characterized by isolated or coalescent papules, erythematous, pruritic or asymptomatic, with zosteriform distribution, often located on the trunk. The authors report a case of a 28-year-old female patient with lesions on the abdomen, with positive stool results for Schistosoma and absence of active symptoms of visceral disease. The case reveals rare exuberant cutaneous manifestation and the importance of the diagnosis of this entity in patients from endemic regions.

A 38-year-old woman with zosteriform skin lesions

“…Therefore, ectopic cutaneous schistosomiasis is characterized by erythematous pruritic papules with a zosteriform distribution that can evolve to nodules and plaques. It mainly affects the thorax—particularly around the shoulders—and abdomen, and it has been reported more frequently in nonimmune travelers visiting endemic areas [ 7 ].…”

Cutaneous schistosomiasis: epidemiological and clinical characteristics in returning travelers

“…Brazilian states that border or contain parts of the São Francisco River (with great opportunity for recreational freshwater swimming) have higher prevalence rates of schistosomiasis. These states include Minas Gerais, Bahia, Pernambuco, Alagoas, and Sergipe 17 . Of note, these states are contiguous along the eastern border of Brazil and played a role in the 16–19th century Atlantic Slave Trade in part because of the cultivation of coffee 18 .…”

“…Skin involvement is clinically difficult to diagnose as the disease is best known for its visceral forms 17,21 . Despite this, reports of schistosomiasis with cutaneous manifestations continue to be published.…”

“…The most common sites of involvement are the lower abdominal, periumbilical, and genital areas. Chronic pruritus without skin lesions is another described presentation 17 . It is thought that the less stable host–parasite relationship in travelers exposed to the parasite allows for deviations of the schistosomes beyond their usual migratory patterns 33 …”

Ectopic cutaneous Schistosoma haematobium in the inguinal region

“…1 Ectopic cutaneous schistosomiasis is uncommon, the pathogenesis is not fully elucidated and a species predominance is not known. 2–5 Patients become infected after the infectious cercariae, living in freshwater, penetrate the skin and enter the circulation. For cutaneous lesions in the anogenital and inguinal areas, it is hypothesized that venous or portosystemic anastomoses between the urinary bladder wall and the skin may enable venous spreading of eggs, especially at times of raised intra-abdominal pressure.…”