Mirroring rarity of ectopic adult Schistosoma haematobium worms in a Sudanese patient

Abstract

INTRODUCTION AND IMPORTANCE: Schistosomiasis is the second most common endemic disease after malaria. This case highlights the rarity of adult S. haematobium worms in a sub-granuloma area and explores how they may reach this site. CASE PRESENTATION: A 25-year-old man presented with hematuria, dysuria, and urinary incontinence, with no prior history of schistosomiasis. Investigations revealed numerous RBCs, pus cells, and S. haematobium eggs in his urine. An abdominal ultrasound showed a thickened bladder wall with filling defects. Cystoscopy revealed two bladder tumors and sandy patches, where multiple mobile worms were found beneath granulomas. The granulomas and worms were completely removed (TURBT). Histopathology confirmed bilharzial granuloma and adult S. haematobium. The patient was treated by empirical regimen postoperatively and reported symptom improvement at follow-up. CLINICAL DISCUSSION: Schistosomiasis is prevalent in tropical and subtropical regions, particularly in Africa, where over 90 % of cases occur in areas with inadequate sanitation. In Sudan, urinary schistosomiasis was first reported in 1919. The disease manifests in two forms: urogenital, caused by S. haematobium, and intestinal, caused by other species. Adult worms reside in the bladder, and their eggs lead to symptoms such as dysuria and "sandy patches." Praziquantel has been the gold standard treatment for over 30 years. Granulomas around adult worms are rare due to their location in the peri-vesical plexus and inability to migrate to bladder cavity. The presence of viable adult worms in uncommon sites may be explained by many possibilities such as angiogenesis in chronic inflammation or aberrant vascularity that early led the small adult worm to reach this site and to grow to this size. CONCLUSION: This case mirroring rarity of the presence of adult S. haematobium in sub-granuloma area, it's also discuss the different possibilities of how this adult worm reach this rare site.