A Case of Intestinal Schistosomiasis with Concurrent Hepatic and Gastrointestinal Involvement Diagnosed by Computed Tomography

ABSTRACT. Intestinal schistosomiasis is an uncommon disease that can present with a range of clinical symptoms and colonoscopic findings, depending on the affected organ, disease extent, and duration. Because these manifestations are not disease-specific, diagnosis can be difficult without clinical suspicion. In addition to fecal examinations to detect parasite eggs, computed tomography (CT) plays a crucial role in diagnosing intestinal schistosomiasis because it can reveal hallmark calcification patterns that are strongly suggestive of Schistosoma infection. A case of a 50-year-old Filipino female patient who presented with persistent abdominal pain is reported in the current study. She had experienced chronic abdominal pain for 10 years, which had acutely worsened over the past several days before presentation, accompanied by diarrhea. A previous colonoscopy performed at a local hospital revealed a 2 cm ulcer at the ileocecal valve. She was subsequently referred to the study institution for further evaluation of possible inflammatory bowel disease and other differential diagnoses. A CT scan performed before the colonoscopy revealed map-like hepatic calcifications and curvilinear calcifications in the bowel wall, suggestive of schistosomiasis. A subsequent colonoscopy with rectal biopsy and molecular analysis of paraffin-embedded tissue confirmed the presence of Schistosoma japonicum infection. The patient responded well to praziquantel.