SCHISTOSOMIASIS IN A NON-ENDEMIC REGION: A DIAGNOSTIC CHALLENGE. A CASE REPORT

Schistosomiasis is a neglected tropical parasitic disease that may cause chronic gastrointestinal and hepatosplenic complications. The case report of a 26-year-old man with a 10-month history of abdominal pain, intermittent diarrhea, progressive abdominal distension, persistent vomiting, and poor oral intake, who was initially diagnosed with Child–Pugh class B hepatic insufficiency. The patient had no conventional risk factors for chronic liver disease; however, epidemiological history revealed consumption and handling of freshwater snails (Pachychilus indiorum) and consumption of untreated spring water. Abdominal computed tomography demonstrated hepatic cystic lesions and ascites, while subsequent ultrasonography showed findings consistent with chronic liver disease. Stool examination revealed structures suggestive of Cryptosporidium oocysts, prompting a two-week course of nitazoxanide. Follow-up hepatic ultrasonography demonstrated a favorable evolution, with a reduction in the number of cystic lesions. Considering the clinical presentation, absence of conventional causes of chronic liver disease, and relevant freshwater exposure, schistosomiasis was considered as a possible underlying etiology. This case highlights the diagnostic challenges of schistosomiasis in non-specific clinical presentations and emphasizes the importance of a detailed epidemiological history and confirmatory testing in patients with unexplained hepatobiliary disease.