S5127 Asymptomatic Schistosomiasis Detected on Screening Colonoscopy

Introduction: Schistosomiasis is a parasitic infection caused by the trematode Schistosoma.¹ Infection may affect multiple organ systems. Gastrointestinal manifestations include abdominal pain, diarrhea, hepatosplenomegaly, hepatic fibrosis, and portal hypertension.¹ 230 million people worldwide are infected with Schistosomiasis, but it is rarely seen in the U.S. as this is not an endemic area.² This is a case of Schistosomiasis in the U.S., with infection in a patient born in an endemic area. Diagnosis was made with biopsies taken during screening colonoscopy. If not for screening colonoscopy, diagnosis and treatment of Schistosomiasis would have been delayed. Case Description/Methods: Forty-six-year-old Uganda-born man with history of asthma, PE, latent TB, who presented for screening colonoscopy. Biopsy of sessile polyp in ascending colon revealed eosinophils and eggs in various stages, consistent with schistosomiasis. Hepatic and viral hepatitis panels, urinalysis, and stool and urine ova and parasite (OandP) studies were obtained. Stool OandP did not have Schistosoma eggs. Remaining laboratory evaluation was unremarkable. Schistosoma mansoni species is suspected given intestinal involvement. Etiology is likely freshwater exposure during childhood in Uganda. Patient was seen by infectious disease and pulmonology. He was treated with praziquantel without complication. Discussion: If symptomatic, intestinal Schistosomiasis presents as abdominal pain, cramping, or diarrhea.² Immune response to eggs may cause fibrosis and chronic complications.¹ Diagnosis usually requires eggs on OandP sample. This is a unique case of Schistosomiasis diagnosed by colonoscopy and biopsy in the U.S. Without colonoscopy, diagnosis, multidisciplinary team involvement, and treatment would have been delayed, especially as there were no eggs on OandP. It is important to consider parasitic infections such as Schistosomiasis in a patient with travel to an endemic area, or if there is a history consistent with chronic infection. Additionally, colonoscopy is a crucial tool that can be used to diagnose parasitic infections such as Schistosomiasis. References 1. Colley D, Bustinduy A, Secor W, and King C. (2014). Human schistosomiasis. The Lancet, 383(9936), 2253-2264. 2. Maguire J (2020). Trematodes (Schistosomes and Liver, Intestinal, and Lung Flukes). Bennett J, Dolin R, Blaser M, Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Disease, 9e. Elsevier Inc. 3451-3462.