Compounded Hepatic Insults: The Convergence of Schistosomiasis, Prior Hepatitis B Exposure, and Autoimmune Hepatitis

Schistosomiasis, a parasitic infection endemic to sub-Saharan Africa, is an uncommon but significant cause of liver disease in developed countries, particularly when compounded by additional hepatic insults. This case report describes a 71-year-old male with severe liver cirrhosis resulting from multifactorial etiologies, including chronic schistosomiasis, viral hepatitis, possible autoimmune hepatitis, and monoclonal gammopathy of undetermined significance (MGUS). Despite initial praziquantel therapy, incomplete treatment allowed for ongoing granulomatous inflammation and fibrosis. The patient’s clinical presentation included portal hypertension, recurrent variceal bleeding, and profound anemia. This case highlights the complex interplay of multiple hepatic insults, the critical need for adherence to antiparasitic therapy, and the challenges of managing overlapping liver pathologies. Increased awareness of schistosomiasis and its role in liver disease is vital for timely diagnosis and intervention, particularly in patients from endemic regions.