First record of prostatic schistosomiasis in Pernambuco, Brazil: signs of chronicity in an endemic disease

ABSTRACT

Schistosomiasis has affected the rural population of Pernambuco, Brazil, for centuries. The hepatosplenic and neurological manifestations of this parasitosis have often been described. However, prostatic schistosomiasis caused by Schistosoma mansoni had never been registered in Pernambuco, thus the importance of this particular case being reported. Case presentation This report records the first case of prostatic schistosomiasis in Pernambuco. A 51-year-old patient underwent partial prostatectomy due to possible cancer and was diagnosed with this ectopic form of schistosomiasis. After the surgical procedure, stool samples were collected to run Kato-Katz parasitological tests, which were positive for S. mansoni, thus confirming that the patient was still infected. Laboratory blood tests and clinical examination showed alterations in liver function and confirmed the presence of hepatointestinal damage. Patient monitoring evidenced that the prostate-specific antigen levels remained high and, one year after the first surgical intervention, a new prostatic puncture showed that schistosomiasis and fibromatosis lesions remained present. It is noteworthy that after triple praziquantel treatment (April 2014, July 2014, February 2015) parasitological stool examinations were all negative for S. mansoni. In conclusion this accidental diagnosis of prostatic schistosomiasis raises doubts regarding the ability of healthcare services to identify and treat ectopic schistosomiasis. The persistently high levels of PSA even after surgical and pharmacological treatment, indicate irreversible damage to tissue caused by S. mansoni. Therefore, healthcare services need to be prepared to investigate and diagnose these cases, with a view to preventing chronic sequelae through early treatment