07 August 2020: Articles
Colonic Polyps an Unusual Manifestation of Schistosomiasis
Challenging differential diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis), Rare coexistence of disease or pathology
Ali Mothanna Al-Zubaidi12ABCDEFG*, Galal Ahmed Bashanfer3BG, Mashhour H. Alqannas4BC, Abdullah Suliman Al Atawi5CFDOI: 10.12659/AJCR.923177
Am J Case Rep 2020; 21:e923177
Abstract
BACKGROUND: Although reports of bilharizial colonic polyps are very rare in the literature, we report a case of a large rectal polyp as a manifestation of chronic intestinal bilharzia. A high index of suspicion in an endemic area is the key factor to avoid unnecessary medical interventions.
CASE REPORT: We report a case of a 24-year-old male patient who was married, born in Taiz North Yemen, and worked as a military soldier. He presented to our clinic with a complaint concerning intermittent lower abdominal pain and several months of rectal bleeding. A colonoscopy was performed at the Endoscopy Unit of King Khalid Hospital, Najran, Saudi Arabia on September 23, 2019 and results showed 2 large rectal polyps, (measuring 4×3 and 2×3 cm), located 10 cm from the anal verge, having wide bases and irregular surfaces that mimicked dysplastic polyps. Both polyps became elevated after a normal saline/methylene blue injection. An endoscopic mucosal resection was successfully performed with no immediate complications. The histopathology showed benign polyps due to Schistosoma-induced colonic infection.
CONCLUSIONS: It is very difficult and challenging to differentiate Schistosoma-induced colonic polyps from other colonic polyps even with an endoscopic evaluation; thus, a high index of clinical suspicion is required mainly in an endemic area, which may prevent the physician from ordering unnecessary interventions and thus avoid severe complications.
Keywords: colonic polyps, Schistosoma, Schistosoma mansoni, Colonoscopy, Rectal Neoplasms, Saudi Arabia, Schistosomiasis, young adult
Background
Schistosomiasis is one of the debilitating tropical diseases globally, and it is a major cause of morbidity and mortality in the Middle East, Asia, Africa, and South America.
Approximately 250 million people are infected, and 700 million people are at risk of infection. In more than 70 countries the infection is endemic with an estimated 660 million infections are concentrated in Africa, which accounts for 85% of the global at-risk estimated [1–3]
The objective of our study was to report a case of a
Case Report
HISTOPATHOLOGY:
The histopathology results showed an infectious polyp containing oval shape Schistosoma eggs with long sharp lateral spine (Figure 3) surrounding by granuloma (Figure 4) indicate chronicity of the infection. In addition, Schistosoma worms were found inside the polyp tissue (Figure 5). The patient received anti-helminthic treatment (praziquantel 40 mg/kg for 3 days) on an out-patient basis after which he improved during follow-up in the out-patient clinic after 3 months when he was asymptomatic.
MACROSCOPIC:
The macroscopic examination showed 2 polypoid soft tissue masses measuring 4×3×3 cm and 4×2×0.5 cm that were fixed in 10% formaldehyde. The cross-sectional surface was firm and whitish with an irregular white lining and superficial ulceration. The slide was stained with hematoxylin and eosin (H&E) and examined using an optical microscope.
MICROSCOPIC:
Microscopic sections revealed polypoid lesions lined by granulation tissue and partially by colonic epithelium. The stroma shows an eosinophil-rich granulomatous reaction surrounding many Schistosoma eggs (Figures 3, 4) and Schistosoma worms (Figure 5). No dysplasia or malignancy was seen.
Discussion
The 2 major species of
Conclusions
It is very rare to encounter a
Figures
References:
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