Uncommon presentation of Schistosoma haematobium infection in a migrant patient: diagnostic and therapeutic challenges

Francesca Carraturo¹Maria Escolino¹Assunta Russo²Angela Spagnuolo²Giovanni Esposito³Claudia Di Mento¹Roberta Colicchio²Paola Salvatore^2,3*Ciro Esposito^1*Mariateresa Vitiello^2*

• ¹Division of Pediatric Surgery, “Federico II” University Hospital, Naples, Italy
• ²Department of Molecular Medicine and Medical Biotechnology, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
• ³CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Campania, Italy

Schistosomiasis is a parasitic infection prevalent mainly in tropical and subtropical countries. We report a case of urinary infection caused by Schistosoma haematobium in a 16-year-old boy from Mali presented to our Institution with a one-month history of gross haematuria. The physical examination revealed an apparently healthy patient with soft abdomen, treatable, but painful to palpation and otherwise no other significant symptoms. The blood tests were within normal range except for eosinophilia. Urinary ultrasound revealed mild bilateral renal pelvis dilation, and distended bladder with thickened walls and multiple papillomatous growths (up to 31 mm in diameter). Cystoscopy confirmed multiple widespread mucosal lesions, and histology revealed severe eosinophilic cystitis with numerous parasitic eggs, observed, also, in parasitological urine examination, confirming the diagnosis of S. haematobium disease. The patient was diagnosed with schistosomiasis-related cystitis and treated with Praziquantel. At two-month post-treatment follow-up urine microscope and eosinophil count were normalized and bladder wall irregularities and focal thickenings of variable size (from 3 mm to 11 mm) were documented. This case highlights the importance of considering haematuria and urinary bladder lesions in patients from areas where Schistosoma spp. is endemic as a strong indicator of parasitosis. Promptly initiating therapy can help prevent potential severe and less manageable consequences.