Ultraschall Med 2013; 34 - KS_CS5_09
DOI: 10.1055/s-0033-1355006

Hepatic Schistosomiasis – A case report

K Metter 1, G Allmendinger 1, A Edelmann 1, M Kurz 1, A Bader 2, M Richter 2, K Vollmer 3, A Schuler 4
  • 1ALB FILS KLINIKEN, Klinik am Eichert, Klinik für Gastroenterologie, Hepatologie und Diabetologie, Göppingen, Germany
  • 2ALB FILS KLINIKEN, Institut für Pathologie, Göppingen, Germany
  • 3Praxis Ehni/Vollmer, Göppingen, Germany
  • 4ALB FILS KLINIKEN, Helfenstein Klinik, Medizinische Klinik, Geislingen, Germany

Purpose: We present the case of a 53 yr old female with mild right upper quadrant abdominal pain as well as signs of mild weakness 6 months after holidays on the Philippines.

Material and methods: Laboratory examinations including microbiological tests, abdominal Ultrasound and liver biopsy were performed.

Results: Laboratory findings were normal except a mild elevated GGT. Ultrasound of the liver showed a peculiar “network pattern” with septa like echogenic periportal regions in the right liver lobe. There was no dilatation of the biliary tree nor swollen lymph nodes were found. All other laboratory examinations were normal as well: there was no eosinophilia in the FBC, microbiological tests including stool and serological examinations for parasitic disease or parasitic antigens were negative as well as the rectal tissue biopsy.

The finally performed liver biopsy revealed beside a granulomatous inflammatory reaction periportally some spheroidal eggs with a small knob pathognomonic for parasitic disease i.e. Schistosomiasis (S. japonicum). The patient was treated with praziquantel 60 mg/kg per day orally in three divided doses for one day. The abdominal pain disappeared very early.

Conclusion: Schistosomiasis is a very common infectious disease in the Middle East, Africa and South America (S. mansoni) as well as in Japan, China, the Philippines and Indonesia (S. japonicum). The typical ultrasound feature of hepatic schistosomiasis is the (peri-)portal echogenic thickening mainly in the right liver lobe as a sign of fibrotic alteration due to the granulomatous reaction and inflammatory involvement in this parasitic disease. The sign is nearly pathognomonic for hepatic involvement of schistosomiasis. Untreated infection leads to presinusoidal portal hypertension. In late stages portal hypertension and hepatosplenomegaly with all its complications is common. Ultrasound is a valuable diagnostic tool to detect hepatic schistosomiasis involvement even if laboratory exams including parasitics tests are negative.

Fig. 1