Schistosoma haematobium causing pulmonary schistosomiasis in a returning traveller

Abstract

Schistosomiasis is infrequently seen in the UK, but remains an important cause of haematuria in endemic areas. It may also be complicated by systemic illness, and can affect multiple organs, including the bladder, liver and lungs. We discuss a case of haematuria associated with lower abdominal discomfort and dry cough/wheeze in a returning traveller diagnosed as pulmonary and urinary schistosomiasis, caused by Schistosomahaematobium This case was particularly notable for the radiological findings seen on CT scan of the chest (figure 2A,B), as well as the characteristic sago nodules discovered within the bladder. It is also unusual to see pulmonary schistosomiasis associated with S. haematobium, an organism more typically characterised by bladder involvement. It is important to consider schistosomiasis and its complications, while rare in the western world, it remains an important differential diagnosis in at-risk groups with considerable morbidity if untreated.

Keywords: infections; infectious diseases; respiratory medicine; tropical medicine (infectious disease); urology.

Figure 1

(A) is a wide view at ×10 magnification showing histology of affected bladder tissue showing urothelial hyperplasia and schistosome eggs. Urothelial hyperplasia describes a thickening of the urothelium in the absence of any structural or cytological atypia. Granulomatous inflammation is also a typical feature. (B) shows schistosome egg seen at ×40 magnification. The schistosome eggs are typically oval (~140×50 μm) with a sharp terminal spine, which can be used to distinguish between Schistosoma haematobium and other common Schistosoma species (S. japonicum and S. mansoni have lateral spines).

Figure 2

High-resolution CT images showing (A) solid and (B) subsolid, non-cavitating pulmonary nodules within the right lung. A typical ground-glass halo is seen surrounding the solid central component of the nodule in (B), which represents haemorrhage. These findings are highly suspicious for pulmonary schistosomiasis given the patient’s history and bladder histology.