A Case of Bladder Schistosomiasis in a 10-year-old Immigrant From Sudan

Author(s):
SriGita Madiraju; Natalie Mainland; Stephen Hong; Isaac Zucker; Gregor Emmert; Firas Petros

Background:

Schistosoma haematobium is a freshwater parasite endemic to Africa and the Middle East. While snails serve as intermediate hosts, second-stage larvae infest humans. These larvae migrate to bladder tissues, where they cause chronic inflammation, leading to fibrosis, obstruction, and squamous cell carcinoma of the bladder.

Hypothesis:

This report presents a case of schistosomiasis found in a 10-year-old immigrant from Sudan. Patient and non-English speaking family presented for phimosis and was incidentally found to have painless gross hematuria and small amounts of bleeding at the end of micturition for approximately 5 months. A retroperitoneal ultrasound showed a 3.7 cm mass at the dome of the bladder. Urine cytology positive for inflammatory cells and eosinophils. No urine culture was done however urinalysis was negative. CBC 6 months prior was negative for eosinophilia. Pediatric tumors range from aggressive rhabdomyosarcomas to more benign urothelial lesions. Cystoscopy was scheduled to obtain tissue diagnosis and rule out rhabdomyosarcoma as this has poor prognosis.

Methods:

Cystoscopy showed two highly vascularized 2.5 centimeters bladder masses and ureteral orifices without calcifications. (Image 1) While the preliminary frozen local pathology report was consistent with rhabdoid malignancy, final outside pathology consult was negative for malignancy and contained numerous parasite eggs of species S. haematobium, with internal miracidium and scattered calcifications. Upon further investigation, the patient’s family reported that he had gone swimming in a freshwater lake during their most recent visit to Sudan.

Results:

The patient was treated with praziquantel, with plans to repeat treatment in 2-4 weeks. He was scheduled for follow-up urine microscopy in 3 months to confirm a successful cure.

Conclusions:

In the United States, schistosomiasis is extremely rare, and primarily affects patients who have immigrated from countries where it is endemic. This case report provides a further data point for presentation and management of schistosomiasis both in the United States and within pediatric populations.