Phimosis of foreskin uncovering schistosomiasis of the urinary bladder: a case report.

Abstract

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

Case description: This report presents a case of schistosomiasis found in a 10-year-old immigrant from Sudan. He initially presented to urology clinic for consideration of circumcision due to phimosis, but thorough patient interview revealed a history of gross hematuria and small amounts of bleeding at the end of micturition associated with occasional abdominal pain for approximately 5 months. A retroperitoneal ultrasound showed a 3.7 cm mass at the dome of the bladder. Cystoscopy was scheduled quickly to rule out underlying tumors such as rhabdomyosarcoma, which often has poor prognosis. Cystoscopy showed two highly vascularized 2.5 cm nodular bladder masses, one on either side of the midline. The bladder was otherwise normal-appearing. The masses were biopsied and sent for frozen section. While the preliminary frozen pathology report was consistent with rhabdoid malignancy, final permanent pathology was negative for malignancy and contained numerous 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. 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. However, he was lost for follow-up.

Conclusions: In the United States (U.S.), 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 U.S. and within pediatric populations, and highlights the importance of a thorough urologic history.