A 21-year-old patient was referred to our unit with a 3-month history of abdominal
discomfort, bloating, and intermittent diarrhea. Physical findings were normal; however,
eosinophilia (4300/µL; 35 %) was detected. Stool analysis for ova and parasites was
negative. Subsequent endoscopy with extended depth of field as well as texture and
color enhancement imaging (TXI) (Olympus EVIS X1 CV 1500) showed small whitish subepithelial
nodules in all segments of the colon, which were especially visible in TXI mode ([Fig. 1]; [Video 1]). In addition, some nodules had a central dark spot which was clearly visible as
a protruding nipple on magnified narrow-band imaging (NBI) ([Fig. 2]; [Video 1]). Histopathological analysis of snare resection specimens showed multiple eosinophilic
granulomas with Schistosoma mansoni eggs in the lamina propria [1]. The dark “nipple” seen on endoscopy was interpreted as a granuloma on the verge
of bursting and releasing parasite eggs into the intestinal lumen. Endoscopic imaging
of egg release of this clarity and detail in intestinal schistosomiasis has not been
published before.
Fig. 1 Texture and color enhancement imaging of whitish nodules and pseudopolyps in intestinal
schistosomiasis; histopathology showed eosinophilic granulomas and Schistosoma mansoni eggs.
Video 1 Whitish subepithelial nodules containing Schistosoma mansoni eggs in the colon of
a 21-year-old male patient. A black nipple can be seen on one of the depicted nodules,
suggesting granuloma burst and egg release into the intestinal lumen.
Fig. 2 Enhanced and magnified endoscopic view (narrow-band imaging) of a whitish nodule
with a dark-colored nipple suggestive of granuloma burst and egg release into the
colonic lumen. There is obvious hypervascularization around the nodule.
A reassessment of the patient’s travel history revealed a visit to Lake Victoria in
Tanzania about 1 year prior to presentation; having swum in the lake he had been infected
with larvae of Schistosoma mansoni. After oral praziquantel treatment his symptoms resolved.
Schistosomiasis is a disease of global concern with about 250 million infections worldwide
[2]. It is probably as old as mankind and is described in ancient Egyptian medical papyri
[3]. Positive DNA samples have been obtained from Egyptian mummies, and the biblical
story of Jericho has been linked to schistosomiasis [3]
[4]. With increased global travel and migration, it is important that physicians in
general and endoscopists in particular should become more aware of travel-associated
diseases. Modern endoscopic imaging can improve medical understanding of such diseases,
especially those with gastrointestinal manifestations.
Endoscopy_UCTN_Code_CCL_1AD_2AZ
Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques
in gastroenterological endoscopy. All papers include a high
quality video and all contributions are
freely accessible online.
This section has its own submission
website at
https://mc.manuscriptcentral.com/e-videos
