An Exotic Visitor
A 44-year-old German man who had been suffering from recurrent abdominal pain, mild scleral icterus, and eosinophilia of unknown origin for several weeks was referred by his general practitioner for ambulatory colonoscopy. The endoscopic finding was a circumscribed irregularity of the mucosa located 30 cm from the anus; a biopsy was taken. Histological examination revealed florid inflammation with a macrogranuloma and an inlaid parasitic structure within an eosinophilic abscess, consistent with schistosomiasis (Figure). The pathogen was morphologically identified as Schistosoma mansoni. In the light of this diagnosis, the patient was asked retrospectively about his travel history and informed us that had he had performed developmental aid work in Uganda. Treatment with praziquantel (40 mg/kg body weight) rapidly led to the resolution of his symptoms. According to the WHO, some 200 million persons worldwide are infected with schistosomes, and 15 000 persons die of schistosomiasis each year in Africa alone. Such cases are very rare in Germany.
Dr. med. Robin Sen Gupta, Institut für Pathologie, St. Agnes-Hospital Bocholt,
Dr. med. Karl Wilke, Gastroenterologie, St. Agnes-Hospital Bocholt
Prof. Dr. med. Michael Vieth, Institut für Pathologie, Klinikum Bayreuth
Conflict of interest statement: The authors state that they have no conflict of interest.
Cite this as: Sen Gupta R, Wilke K, Vieth M: An exotic visitor. Dtsch Arztebl Int 2018; 115: 123. DOI: 10.3238/arztebl.2018.0123
Translated from the original German by Ethan Taub, M.D.