Colonic schistosomiasis mimicking cancer, polyp, and inflammatory bowel disease: Five case reports and review of literature

Abstract

BACKGROUND

Schistosomiasis, officially named as a neglected tropical disease by The World Health Organization, is a serious parasitic disease caused by trematode flukes of the genus Schistosoma. It is a common infectious disease, endemic in more than 78 countries. The disease can involve various organs and poses far-reaching public health challenges.

CASE SUMMARY

Here, we present a series of five patients with variable presentations: an asymptomatic patient who was diagnosed with colonic schistosomiasis upon screening colonoscopy; 2 patients with clinical suspicion of colonic cancer; and 2 patients with a clinical diagnosis of inflammatory bowel disease. All patients were subsequently confirmed to have colonic schistosomiasis after colonoscopy and histopathologic examination. The clinical manifestations, colonoscopy features and histologic findings of the patients are described. Most of the patients showed significant clinical improvement following administration of oral praziquantel.

CONCLUSION

Intestinal schistosomiasis can present with features mimicking other gastrointestinal conditions. This disease should be a diagnostic consideration in patients who live in or have traveled to endemic areas.

Keywords: Schistosomiasis; Schistosoma; Colon; Polyp; Ethiopia; Case report

Core Tip: Schistosomiasis still poses significant morbidity to individuals, especially those in endemic areas. Its variable clinical presentation, protracted course, and nonspecific endoscopic findings frequently lead to erroneous diagnoses. Having a high index of clinical suspicion, actively inquiring about exposure or travel history, utilizing epidemiologic surveys to understand disease distribution, correlating symptoms with basic laboratory tests (especially eosinophil count), and obtaining histopathologic examination of colonic mucosa are essential in making a conclusive diagnosis. Confirming the diagnosis is important, as colonic schistosomiasis can be effectively treated with anthelminthic therapy (praziquantel) obviating the need for unnecessary medical treatments and invasive surgical procedures.