A fluke diagnosis.
نویسندگان
چکیده
To cite: Toms C, Morgan SM-A, Samaan MA, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2016216169 DESCRIPTION A 42-year-old man presented to the emergency department with a 1-week history of left iliac fossa pain, fever and diarrhoea. He reported no recent travel or unwell contacts. He originated in Sierra Leone but has lived in the UK for 15 years. His last visit to Sierra Leone was 5 years ago. On examination, left iliac fossa tenderness was noted with suspicion of a palpable mass. He was febrile, tachycardic and normotensive. Blood tests revealed an elevated C reactive protein of 120 mg/L and a white cell count of 15.7 (neutrophils 12.7)×10/mL. The remainder of his blood tests were within normal limits, and blood cultures grew no organisms. Chest and abdominal X-rays revealed no abnormalities. CT imaging demonstrated inflammation of the proximal sigmoid colon with an adjacent collection (figure 1). Possible sigmoid diverticular changes were also reported leading to a working diagnosis of acute diverticulitis with a sealed localised perforation. Conservative treatment with intravenous antibiotics and analgesia resulted in a good clinical recovery and improvement of biochemical inflammatory markers. The patient was discharged, and an outpatient colonoscopy was planned. Colonoscopy demonstrated a mild, patchy, resolving sigmoid colitis but no evidence of diverticular disease (figure 2). Sigmoid biopsy samples revealed a viable schistosome ovum with surrounding granuloma, eosinophils and Splendore-Hoeppli phenomenon (figure 3A, B). The ovum was subtyped as Schistosoma mansoni confirming the diagnosis of chronic schistosomal colitis with paracolic abscess formation. Definitive treatment with a single, oral dose of praziquantel was administered. This is the treatment of choice for all species of schistosomiases and has a reported cure rate of 65–90%.
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ورودعنوان ژورنال:
- BMJ case reports
دوره 2016 شماره
صفحات -
تاریخ انتشار 2016