CASE OF THE WEEK
2019-26 / AUGUST 12
(CONTRIBUTOR: JENNIFER GORDETSKY)
A 30 year old male who immigrated from Africa presents with gross hematuria. Cystoscopy and biopsy are performed.
Quiz
1. What is the correct diagnosis?
a. shistosoma
b. Miliary tuberculosis
c. Herpes simplex virus
d. Parvovirus
e. Urinary lithiasis
1. a
1. Schistosoma
This is a case of shistosoma infection, a parasitic flatworm that involves the urinary tract. The disease is endemic in Africa, the Nile river valley and the Middle East. Patients get infected by swimming in fresh water during which cercariae are released from snails and penetrate the skin of the human host. The worms migrate through the lung into the portal system where they mature into adults following which they reach the bladder venules and lay their eggs which can accumulate in the bladder wall. The two main types of schistosomas are Schistosoma haematobium which have eggs showing terminal spines and Schistosoma mansoni which have eggs with lateral spines. The eggs elicit a significant mixed inflammatory and granulomatous reaction which can lead to mucosal ulceration, fibrosis, thickening and calcifications of the bladder wall. The mucosa may also undergo squamous or glandular metaplasia and dysplasia. Long standing infection can lead to extensive calcification of the urinary tract, renal failure, pulmonary hypertension and bladder cancer.
Asundi A, Beliavsky A, Liu XJ, Akaberi A, Schwarzer G, Bisoffi Z, Requena-Méndez A, Shrier I, Greenaway C. Prevalence of strongyloidiasis and schistosomiasis among migrants: a systematic review and meta-analysis.
Lancet. Glob Health. 2019 Feb;7(2):e236-e248.
Jennifer Gordetsky
Vanderbilt university medical center
jennifer.b.gordetsky@vumc.org
Bladder
Shistosomiasis, bladder, parasite