Hepatosplenic schistosomiasis presenting as granulomatous hepatitis in an immigrant from the Philippines with pulmonary tuberculosis, tuberculous lymphadenitis, and a history of alcohol abuse.

Schistosomiasis is the most common of the trematode infections, affecting more than 200 million people worldwide.1,2 Hepatosplenic schistosomiasis occurs primarily with infection due to Schistosoma mansoni and less often with Schistosoma japonicum. If left untreated patients may ultimately develop massive hepatosplenomegaly, portal hypertension, and variceal hemorrhage.1–3 The diagnosis of hepatosplenic schistosomiasis and the severity of periportal fibrosis can be made on liver biopsy, although liver ultrasonography may provide useful diagnostic clues.4,5 Early treatment with praziquantel may result in reversal of periportal fibrosis.5–7 In the patient presented, the diagnosis of hepatosplenic schistosomiasis was masked by tuberculous involvement of the liver and alcoholic hepatitis. Hepatosplenic schistosomiasis should be considered in the investigation of chronic liver disease in patients from endemic areas of the world.