A case of encapsulating peritoneal sclerosis in a patient with chronic schistosomiasis

Abstract

Encapsulating peritoneal sclerosis (EPS) is a debilitating condition, mainly associated with long-term peritoneal dialysis, where up-regulation of intra-abdominal inflammatory pathways leads to a fibrocollagenous peritoneal membrane formation resembling a cocoon. EPS causes intestinal encapsulation leading to bowel obstruction and dilatation. Chronic schistosomiasis is characterized by dysregulation of pro-inflammatory and anti-inflammatory cytokines. EPS has never been reported before in patients with chronic schistosomiasis. We report the first, to our knowledge, case of a 57-year-old male originated from Burkina Faso with chronic intestinal and urogenital schistosomiasis and EPS. Although causality cannot be established solely by this case, we hypothesize that EPS may be the result of chronic inflammatory activation, due to immune dysregulation driven by chronic schistosomiasis. The potential pathogenetic linkage between these two conditions should be further explored.

Keywords: Abdominal cocoon; Ascites; Chistosomiasis; Encapsulating peritoneal sclerosis; Schistosoma haematobium.

Fig. 1

Abdominal CT scan and rectosigmoid biopsy specimen images. A. Maximum intensity projection coronal plane: the image shows ascites, floating intestinal loops and peritoneal thickening. B. Sagittal plane: the image shows ascites, peritoneal thickening (white arrow) and bladder wall calcification (red arrow). C. Axial plane: the image shows ascites, floating intestinal loops and intestinal wall calcifications (white arrows). D. Axial plane images pre- and post-intravenous contrast media infusion, showing the thickening and the enhancement of peritoneum. E. Axial plane images showing the cocooning of the intestinal loops (red arrow), the bladder wall calcifications (blue arrow) and the intestinal wall calcifications (white arrow) without the administration of oral contrast media. F. Partially calcified as S. haematobium ova with terminal spine (magnification100x and 400x) (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article).