Unusual cause of lesions in the descending duodenum and liver: A case report and review of literature

Abstract

The descending duodenum is rarely involved in Schistosoma japonicum (S. japonicum) infection. Here, we report a case of acute Schistosoma infection, which presented with abdominal pain, abdominal distension and irregular fever. Tumor-like lesions were observed in the descending duodenum. Simultaneously, heterogeneity in hepatic perfusion was demonstrated by dynamic computed tomography scanning. Biopsy of the descending duodenum showed the deposition of Schistosoma eggs. Following administration of the antihelminthic drug praziquantel, the patient showed rapid clinical improvement. In conclusion, we report a patient with acute S. japonicum infection presenting as tumor-like lesions in the descending duodenum and heterogeneity of blood perfusion in liver parenchyma.

Keywords: Duodenum; Heterogeneity; Liver; Schistosoma japonicum; Tumor-like lesions.

Figure 1

A 47-year-old male patient with acute Schistosoma japonicum infection underwent endoscopic examination, endoscopic ultrasonography and dynamic computed tomography scanning at the baseline visit. A, B: Upper gastrointestinal endoscopy showing protrusive lesions in the esophagus (A), swollen mucosa and protrusive lesions in the descending duodenum (B); C, D: Endoscopic ultrasonography revealing a hypoechoic mass in the muscularis mucosa of the esophagus (C, arrow), thickening of the descending duodenal wall, and destruction of the descending duodenal wall (D, arrow); E-G: Dynamic computed tomography showing heterogeneous hypointensity in the liver (E, arrow), thickening of the descending duodenal wall (F, arrow), swollen mesentery around the arteries (G, arrow), and ascites; H: Biopsy of the descending duodenum showing deposition of Schistosoma eggs.

Figure 2

Following administration of praziquantel, the patient with acute Schistosoma japonicum infection received a complete check-up at the follow-up visit. A, B: Upper gastrointestinal endoscopy showing protrusive lesions of the esophagus (A) and normal mucosa in the descending duodenum (B); C: Endoscopic ultrasonography revealing slight thickening and normal layer of the descending duodenal wall; D-F: Dynamic abdominal computed tomography showing homogeneous hepatic perfusion on the portal phase (D), slight thickening of the descending wall (E, arrow), shrinkage of the swollen mesentery to normal size (F, arrow), and disappearance of ascites.