Unusual Presentations of Intestinal Schistosomiasis

Schistosomiasis is a common parasitic infestation that affects 200 million people worldwide. There are more than 76 endemic countries that suffer from this infestation, leading to 200,000 deaths annually. Intestinal schistosomiasis is known to cause a variety of serious gastrointestinal complications. Thus, it is important to diagnose it early to prevent such complications and relieve symptoms early. A typical infection with intestinal schistosomiasis tends to present with chronic diarrhea, abdominal pain, dysentery, and in severe cases portal hypertension and hepatosplenomegaly. However, in this study the authors report two cases that came with unusual presentations of intestinal schistosomiasis during their outpatient clinic evaluation. Case Presentation: The first patient is a 33-year-old male Yemeni national who was referred for investigation of a pedunculated rectal polyp. The patient was otherwise asymptomatic with no significant medical history. The second patient is a 39-year-old male Saudi national who presented with constipation, abdominal pain, and bloating. The patient was initially diagnosed as a case of irritable bowel syndrome and was managed conservatively for 2 years with no improvement. Conclusion: Histopathological evidence via biopsies revealed intestinal schistosomiasis in both patients. Therefore, in endemic areas it remains important to keep intestinal schistosomiasis in the differentials when dealing with vague intestinal signs and symptoms. It is also important to not rule out schistosomiasis from a negative stool egg screening alone as this tool tends to yield false negative results during acute infections and low-intensity chronic infections.