Ischaemic colitis (necrotizing colitis, pseudomembranous colitis) in acute schistosomiasis mansoni: report of two cases

Abstract

Two cases of ischaemic necrosis of the sigmoid colon (necrotizing colitis) are reported in 2 brothers aged 7 and 4 years, diagnosed within a 10 d interval. The children had bathed in streams suspected to be contaminated by Schistosoma mansoni about 50-60 d before the onset of acute disease. Both patients had been previously exposed to schistosome-infected streams without showing signs or symptoms of infection. Before admission, S. mansoni eggs had not been found in the stool. Both patients presented with an apparently identical, relatively symptomatic clinical course with rapid evolution to an acute abdomen. Laparotomy disclosed, in both patients, extensive necrosis (ischaemic necrotizing colitis of schistosomal aetiology) of about 20 cm in the first child and 8 cm in the second, extending from part of the descending colon to the sigmoid. The patients were successfully operated upon (hemicolectomy plus colostomy). The histopathological findings were similar in both patients. Ischaemic necrosis with complete destruction of the mucosa and part of the submucosa was detected in the first case; in the necrotic areas a few eggs of S. mansoni were seen, with no granulomatous reaction, but surrounded by cell shadows, pycnotic nuclei and amorphous material. Necrosis extended to the muscular layer and serosa, in which schistosome granulomas in the necrotic-exudative phase were seen, as well as diffuse granulocytic exudate and fibrin. Sections of tissue from both patients contained numerous eggs and granulomas all in the same exudative phase in regional lymph nodes and near the thrombotic vessels. After surgery, the 2 patients progressed similarly. About 10 d after hospital discharge, the patients received anti-schistosomal treatment with oxamniquine. No further sign of infection was detected at subsequent recall visits.

Pseudomembranous colitis: Not always Clostridium difficile

“…18,19 Other rarer infectious causes of pseudomembranous colitis identified in case reports include Clostridium ramosum, Entamoeba histolytica, Klebsiella oxytoca, Plesiomonas shigelloides, Schistosomiasis mansoni, and Salmonella and Shigella species. [20][21][22][23][24][25][26] Additionally, there have been two reports of Strongyloides stercoralis hyperinfection manifesting as pseudomembranous colitis. 27,28 Ischemia Colon ischemia usually affects elderly or debilitated patients who have multiple comorbidities.…”

Acute schistosomiasis mansoni: revisited and reconsidered

“…In such patients, the absorption of drugs given orally may be impaired. Neves et al (1993) reported two cases of ischaemic necrosis of the sigmoid colon in two brothers aged seven and four years. Laparotomy disclosed, in both children, extensive necrosis of the descending colon and sigmoid.…”

Acute Schistosomal Colitis Preceded by Katayama Syndrome

“…Patients with acute Schistosoma mansoni infection have been diagnosed at times as having typhoid fever, hepatitis, pancreatitis, and appendicitis, only to be cured when infection with schistosomiasis has been discovered after a long search. [14] In this case, the patient's illness was complicated by acute colonic schistosomiasis, confirmed by the finding of viable ova on histopathological examination of colonic mucosa specimens. The absence of ova in stools does not rule out schistosomiasis since it has been estimated that thousands of eggs per day must be excreted to be readily visualized on routine microscopic examination of stools.…”

“…[9] Severe complications have been reported with schistosomiasis such as hemorrhagic diarrhea, obstruction secondary to an inflammatory mass, acute appendicitis, intestinal intussusception arising from a mucocele of the appendix, and ischemic colitis. [10][11][12][13][14] For a patient coming from an endemic country with a suspected light infection, the reasonable approach for diagnosis would be serum antibody titer or polymerase chain reaction assay. [6] Other investigations include serologic tests for the detection of the parasite antigens.…”