Schistosomiasis is one of the neglected tropical diseases and is endemic in more than 70 countries. Herein, we present a case of schistosomiasis colitis in the USA.
A 21-year-old man born in Libya, resident in USA for more than 9 years, was referred to the Gastroenterology consultation for chronic diarrhea (8 bowel movements per day of liquid feces), intractable diffuse abdominal pain, associated with subjective fevers, chills, nausea, vomiting (nonbloody), and decreased oral intake. Laboratory workup was negative for leukocytosis; stool cultures were negative. Computed Tomography (CT) abdomen and pelvis showed diffuse colitis with bowel wall thickening. Patient was treated with ciprofloxacin and metronidazole. Given no improvement in symptoms, Colonoscopy was performed showing diffusely congested and hyperemic mucosa. Random colonic biopsies were positive for parasitic infection associated with non-necrotizing granulomas most consistent with schistosomiasis. This was followed by a positive serology test for Schistosoma. He was started on praziquantel (40 mg/kg) with improvement in diarrhea frequency prior to discharge to follow up in clinic.
Colonic schistosomiasis is common in endemic areas (Africa, South America and Asia) and the endoscopic findings can be confounded with inflammatory bowel disease with just a few reports published in these countries and very rare in the USA. The most common presentation is a form of symptomatic chronic active colitis with diarrhea and abdominal pain. The diagnostic gold standard is the histology. Even though new cases have not occurred recently in USA, we should remain aware of schistosomiasis colitis for patients who came from foreign epidemic areas.