Gallbladder schistosomiasis

Abstract

Schistosomiasis is an infectious disease caused by parasitic flatworms of the genus Schistosoma. The species Schistosoma mansoni is associated with hepatosplenic disease. Schistosomiasis involving the gallbladder alone is highly unusual, with a few cases reported. Herein, we present the case of a woman from a region with endemic schistosomiasis who presented with a painless solid lesion and wall thickening of the gallbladder. She underwent an uneventful laparoscopic cholecystectomy. Microscopic examination of the surgical specimen revealed Schistosoma mansoni eggs associated with granulomatous reaction, leading to the diagnosis of schistosomiasis of the gallbladder, prompting subsequent treatment with praziquantel and follow-up. This case illustrates the importance of suspicion for this diagnosis in endemic areas, as it can be misdiagnosed with malignancy if not examined microscopically. Complications and treatment strategies are poorly characterized for the few cases of schistosomiasis; reporting this case can serve as a helpful reminder of a rare presentation of this disease.

Keywords: Gallbladder Diseases; Gallbladder Neoplasms; Parasitic Diseases; Schistosomiasis.

Figure 1. Abdominal Computed Tomography scan shows generalized thickening of the gallbladder wall (white arrows) and the polypoid and solid components (yellow marks) in axial (A), coronal (B), and sagittal (C) planes.

Figure 2. A – Macroscopic view of the surgical specimen with the polypoid aspect of the mucosa (scale bar = 4 cm); B – Gallbladder mucosa showing S. mansoni eggs (black arrows), surrounded by chronic inflammatory infiltrate rich in eosinophils (HE, 20x); C – Schistosoma mansoni egg with lateral spike is indicated by the black arrow, present in a blood vessel in the gallbladder mucosa (HE, 40x).