Acute Appendicitis Associated With Schistosoma Species. (11th September 2019)

• Record Type: Journal Article
• Authors: Castillo, Jesus Rico; Alame, Diana; Tuluc, Madalina; Nagurney, Michelle; Ghusson, Noha
• Is Part Of: American journal of clinical pathology. Volume 152(2019)Supplement 1
• Page Start: S60
• Page End: S61
• Publication Date: 2019-09-11
• Subjects: Diagnosis, Laboratory -- Periodicals; Pathology -- Periodicals; 616.07
• DOI: 10.1093/ajcp/aqz113.058
• Languages: English
• ISSNs: 0002-9173

Abstract

Abstract: Objectives: Schistosomiasis is a public health problem in tropical regions of the world, highly endemic in sub-Saharan Africa but uncommon in the United States. It is considered second only to malaria as the most devastating human parasitic diseases, and it is mainly classified as urinary or intestinal. Here we report a rare case of acute appendicitis associated with Schistosoma spp. Case Presentation: A 28-year-old male presented to our institution in October 2018 with a 2-day history of periumbilical and right lower quadrant abdominal pain associated with nausea, vomiting, fever, and chills. CT scan of the abdomen in the emergency department showed hyperenhancement of the appendix, with an increased diameter of 10 mm and infiltration of the adjacent fat, compatible with appendicitis. The patient was administered intravenous piperacillin-tazobactam and underwent an uncomplicated laparoscopic appendectomy. Histopathological examination of the appendectomy specimen reveals neutrophilic infiltrate of the wall consistent with acute appendicitis, with granulomatous inflammation surrounding parasitic eggs measuring 60 by 37 μm morphologically consistent with Schistosoma spp. within the wall. Additionally, Ziehl-Neelsen stained negative. Significant travel history included a trip to Lake Malawi approximately 9 years prior to this presentation where he frequently swam in freshwater lakes. He does not recall developing an acute illness associated with this travel. Discussion: Chronic schistosomiasis is the result of host immune responses to schistosome eggs that become lodged in the capillaries or organs and cause granulomatous reactions. Chronic inflammation can lead to bowel wall ulceration, hyperplasia, and polyposis and, with massive infection, to periportal liver fibrosis, dysuria, and hematuria. Small bowel involvement is very unusual and only rare cases of appendicitis have been reported worldwide. Additionally, Ziehl-Neelsen stained negative favoring other Schistosoma species instead of S mansoni, S intercalatum, or S japonicum . Fortunately, the patient underwent surgery, received praziquantel, and achieved full recovery.