First record of schistosoma intercalatum in upper Egypt; an abnormal locality and presentation simulating lymphoma

ABSTRACT

Schistosomiasis due to Schistosoma intercalatum is highly restricted to the Western regions of equatorial Africa. Its main clinical manifestation is rectal bleeding. A case is described of a 14 year old boy living in Upper Egypt who was presented to General Surgery Department, Sohag University Hospital, South Valley University, complaining of vague abdominal pain, rectal bleeding, multiple abdominal masses and splenomegaly. Laparotomy revealed moderate splenomegaly, multiple hepatic focal lesions, mesenteric and paracolic lymphadenopathy, and multiple nonobstructing colonic masses. Splenectomy was done, multiple lymph node biopsies and wedge liver biopsy were taken. Endoscopic rectal biopsy was also done. The primary diagnosis was abdominal lymphoma with hepatic and splenic involvement. Histopathological examinations of these biopsies revealed congested spleen and multiple bilharzial granulomata effacing the whole lymph nodal architecture, infiterating the portal tracts of the liver, and surrounding terminally spined-eggs of the rectal wall. Staining of the rectal specimen by Modified Ziehl-Neelsen showed red coloration of the egg-shell characteristic of S. intercalatum. We here announce the first record of S. intercalatum in Upper Egypt, Sohag Governorate and also report all interesting unusual presentation of S. intercalatum schistosomiasis by abdominal lymph node enlargement simulating lymphoma