Colonic polyps: a rare clinical manifestation of schistosomiasis (a case report).

Schistosomiasis is caused by parasitic blood flukes. It is one of the neglected tropical diseases (NTDs) and has variable manifestations depending on the species involved. Eggs and not adult worms are mostly responsible for the resultant pathologies commonly involving the small intestines. Colon polyps resulting from schistosomiasis represent a rare entity despite the endemicity of Schistosoma mansoni in the tropical regions. Praziquantel is the mainstay of treatment. Case presentation is of a 28 year old male with complaints of bloating, mild abdominal pain and loose stools over two weeks.On examination, the patient´s abdomen was soft on palpation with a liver span of 8 cm and a non-palpable spleen. Preliminary tests included stool microscopy which was negative for ova and cysts, negative for stool H. pylori antigen. Colonoscopy revealed a polyp at the caecum and pan-colonic erosions. Microscopy of the polyp showed numerous schistosome ova. The indolent picture of this particular patient makes it a unique case as the likelihood of the diagnosis not being schistosomiasis is greater than other differential diagnoses. The take-home message is that a high index of suspicion is needed in the diagnosis of colonic polyps resulting from schistosomiasis as it presents with non-specific manifestations and inconclusive laboratory and endoscopic findings.

Primary rectal melanoma in an African female: a case report.

Primary malignant melanoma occurs frequently on the skin and is rare in people of African ancestry. The rectal region is an unusual site for non-cutaneous melanoma. We report a case of a 58-year- old African woman presenting to a Kenyan hospital with lower abdominal pain and per rectal bleeding for three months, who underwent a colonoscopy that showed a rectal polypoid mass at the anorectal region. Histology of the mass showed pigmented pleomorphic cells which had positive stains for melanoma markers. Staging workup performed, including magnetic resonance imaging (MRI) of the pelvis and positron emission tomography (PET) - computed tomography (CT), showed regional lymph node involvement but no evidence of distant metastases. Surgery was recommended to the patient but she died eight months after the diagnosis. The case illustrates that primary rectal melanoma, though rare in Africans, is an aggressive disease which can be easily misdiagnosed as hemorrhoids or rectal adenocarcinoma.

Intestinal Tuberculosis Presenting with Gastrointestinal Bleeding in Patient on Warfarin Therapy.

Background: Intestinal tuberculosis (ITB) constitutes less than 5% of overall cases of extrapulmonary disease and mostly affects the ileocecal region. The presentation and radiologic findings in enteric tuberculosis can mimic Crohn's disease (CD). Case Presentation. We present a case report of an African woman who presented to a Kenyan hospital with lower gastrointestinal bleeding while on anticoagulation for valvular atrial fibrillation, and was diagnosed with intestinal tuberculosis after colonoscopy, biopsy, and positive staining for tuberculous bacilli. Conclusion: Intestinal tuberculosis causing gastrointestinal bleeding is rare but should be suspected in patients living in TB endemic regions.

Whole Genome Sequencing Reveals Virulence Potentials of Helicobacter pylori Strain KE21 Isolated from a Kenyan Patient with Gastric Signet Ring Cell Carcinoma.

Helicobacter pylori (H.pylori) infection is etiologically associated with severe diseases including gastric cancer; but its pathogenicity is deeply shaped by the exceptional genomic diversification and geographic variation of the species. The clinical relevance of strains colonizing Africa is still debated. This study aimed to explore genomic features and virulence potentials of H. pylori KE21, a typical African strain isolated from a native Kenyan patient diagnosed with a gastric cancer. A high-quality circular genome assembly of 1,648,327 bp (1590 genes) obtained as a hybrid of Illumina Miseq short reads and Oxford Nanopore MinION long reads, clustered within hpAfrica1 population. This genome revealed a virulome and a mobilome encoding more than hundred features potentiating a successful colonization, persistent infection, and enhanced disease pathogenesis. Furthermore, through an experimental infection of gastric epithelial cell lines, strain KE21 showed the ability to promote interleukin-8 production and to induce cellular alterations resulting from the injection of a functional CagA oncogene protein into the cells. This study shows that strain KE21 is potentially virulent and can trigger oncogenic pathways in gastric epithelial cells. Expended genomic and clinical explorations are required to evaluate the epidemiological importance of H. pylori infection and its putative complications in the study population.

Benign Recurrent Intrahepatic Cholestasis (BRIC): An African Case Report.

Benign recurrent intrahepatic cholestasis (BRIC) is a rare disorder characterised by recurrent episodes of cholestatic jaundice. First described in 1959, BRIC has been reported in patients all over the world including of African descent. Here, we describe a case of a 21-year-old male with recurring episodes of cholestatic jaundice where we diagnosed BRIC and terminated an episode with rifampicin. To our knowledge, this is the first case report of BRIC diagnosed in Africa.