Unexpected Schistosomiasis Diagnosed After Appendectomy in a Migrant Child

BACKGROUND Schistosomiasis is a parasitic infection caused by trematodes of the genus Schistosoma, endemic in sub-Saharan Africa, the Middle East, and Asia. In high-income, non-endemic countries, it remains underrecognized and is often identified incidentally, particularly among asymptomatic migrants and refugees. Because of low clinical suspicion and the absence of specific laboratory abnormalities, the disease may remain undetected for years and be discovered only through unexpected intraoperative findings or targeted imaging. Due to increasing global migration, clinicians in non-endemic regions must remain alert to such presentations. CASE REPORT A 10-year-old Eritrean girl, residing in Switzerland for 6 months, presented with acute right lower quadrant abdominal pain and vomiting. Laparoscopic appendectomy confirmed acute appendicitis, but intraoperative exploration revealed multiple punctate white hepatic lesions. Histopathologic examination of liver biopsies showed granulomatous inflammation containing Schistosoma mansoni ova, with species confirmation by polymerase chain reaction analysis. The patient had no eosinophilia and denied urinary or gastrointestinal symptoms. She received 2 doses of praziquantel (40 mg/kg) administered 14 days apart. The postoperative course was uneventful; she remained asymptomatic at follow-up. Her family members were referred for screening and treatment. CONCLUSIONS This case underscores the need for a high index of suspicion concerning neglected tropical diseases in pediatric migrants from endemic regions, even when presenting with unrelated pathologies and normal laboratory results. Incidental intraoperative detection of hepatic lesions prompted targeted biopsy, which proved decisive for diagnosis. Early recognition, timely treatment, and heightened clinical awareness can prevent long-term complications and support targeted screening integration into non-endemic healthcare systems.