We report the case of a 30-year-old male from Sub-Saharan Africa with a history of angiodema, who had no previous surgery or chronic treatment.
She consulted for diarrhea with mucus and blood for several weeks.
Physical examination revealed erythema multiforme and non-painful hepatomegaly.
The blood count showed a hemoglobin of 10.3 g, 53,000 platelets, 3,460 leukocytes, with a normal formula.
Hepatic function showed elevated liver enzymes (GOT 48, GPT 63) and prothrombin activity 53%.
Immunochemistry showed total IgE of 960 mg (VN < 100).
The extension study of peripheral blood showed moderate peripheral anitosis with polysegmentation of neutrophils, not appreciating atherosclerotic cells.
Serology for hepatotropic virus, HIV, Toxoplasma, cytomegalovirus, Salmonella, Brucella, hydatidosis, leishmaniosis, fasciolosis and amebistiasis was negative for 1/512.
Fecal, urine and stool cultures were negative.
Abdominal ultrasound showed indirect signs of chronic liver disease and homogeneous thickening of 16 cm with varices in splenic hilium.
Upper endoscopy shows varices in esophagus grade II/IV and in stomach a very congestive gastric mucosa especially in the antrum and gastric body and varices in gastric cardia of pseudotumoral aspect.
Placement is achieved by appreciating a recipeequial with a small polyp of 0.6 cm that is removed.
The pathological study of rectal biopsies showed a mixed inflammatory infiltrate with focal abscess formation and moderate presence of eosinophils, with no noticeable depletion of goblet cells.
After performing multiple cuts of polypoid formation, in the submucosa there are oval structures of refractive cuticle measuring 150 forms of maximum diameter with internal massive calcification.
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With the diagnosis of schistosomiasis with rectal and hepatic involvement, treatment was initiated with praziquantel at a dose of 50 mg/kg of weight in three doses.
The patient improved clinically and analytically, normalizing liver function parameters and blood count.
Upper gastrointestinal endoscopy and abdominal ultrasound six months after treatment revealed the disappearance of varices, signs and symptoms of chronic liver disease.
