Hepatosplenic schistosomiasis: playing hide-and-seek with an elusive parasite

Abstract

A 27-year-old man of Eritrean origin presented with persistent left-sided abdominal pain. Initial investigation showed signs of liver fibrosis, portal hypertension and splenomegaly. A diagnosis of hepatosplenic schistosomiasis was suspected on grounds of elevated total IgE, grey area antischistosomiasis antibodies and the high endemic status of his native country. However, repeated microscopy of faecal and urine samples, as well as rectal biopsies, failed to demonstrate schistosomal eggs. Finally, the diagnosis of hepatosplenic schistosomiasis was established through demonstration of a egg in a liver biopsy taken in an attempt to clarify the cause of the above findings. The patient had recently been treated for uncomplicated malaria. Lowered schistosomiasis worm/egg burden and hence reduced sensitivity of classic microscopy-based schistosomiasis testing was attributed to the antischistosomal activity of the antimalarial chemotherapy.

Clinical Spectrum of Schistosomiasis: An Update

“…In contrast to cirrhosis, in hepatosplenic schistosomiasis, hepatic function is preserved overall [45]. Several studies have demonstrated a correlation between disease severity (measured by i.e., organomegaly) and quantitative fecal egg output [47]. Hematochemical alterations, such as thrombocytopenia and leukopenia, classically attributed to "hypersplenism," might be due to intrasplenic blood stasis rather than sequestration with abnormal splenic function.…”

“…In contrast to cirrhosis, in hepatosplenic schistosomiasis, hepatic function is preserved overall [ 45 ]. Several studies have demonstrated a correlation between disease severity (measured by i.e., organomegaly) and quantitative fecal egg output [ 47 ].…”

Anemia in a young Guinean male

“…Micronutrient deficiency, including B12 and folate deficiency as observed in our patient, has been observed in chronic schistosomiasis, presumably from malabsorption and reduced dietary intake due to poor appetite. 4,5 Presence of dacrocytes is usually suggestive of a myelophthisic process, which is rare but has previously been identified in the bone marrow of a patient with schistosomiasis. 6 However, our patient's bone marrow pathology was non-specific and did not demonstrate findings characteristic of a myelophthisic process including fibrosis or infiltrate.…”

“…As such, the patient's bleeding was attributed to chronic intestinal schistosomiasis. Of note, while stool microscopy is generally considered the gold standard for diagnosing schistosomiasis, rectal biopsies actually have higher diagnostic sensitivity 4 . Rectal biopsies are particularly useful when there is a high clinical suspicion for schistosomiasis despite negative laboratory‐based testing.…”

Clinical and Preclinical Imaging of Hepatosplenic Schistosomiasis

“…Detection of varices with non-invasive capsule endoscopy -Capsule endoscopy involving transit of an ingestible wireless camera along the digestive tract can be performed to visualise the entire small bowel when simultaneous therapeutic intervention or tissue sampling is not required. Capsule endoscopy has been successfully used in a pilot study to detect oesophageal varices in HSS and enabled the identification of small bowel lesions in PH together with edema, erosions and scarred mucosa [67,68]. Although clinically significant esophageal and rectal varices are typically visible endoscopically, ectopic varices may require cross sectional or multiplanar portal venous phase CT or MRI for diagnosis.…”