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Image: This 32 year old male emigrated from Cote d'Ivoire in 2006 and, in 2007 in Montreal, described intermittant hematuria of 8 years duration. He had been advised in Cote d'Ivoire, that this was due to his high intensity sports. He was otherwise well. A CT of the abdomen revealed a calcified bladder wall and a thickened bladder wall at 12 - 2 o'clock. The urologist noted three ulcers of the bladder mucosa wall and resected them. What was the diagnosis? |
Image: The resected material was packed with degenerate schistosome eggs; no neoplasm was found. The urine had small numbers of calcified eggs. The schistosoma serology (ELISA-mixed S. hematobium and S. mansoni- National Parasit. Ref. Centre, Canada) was positive. Hemoglobin, WBC and periferal eosinophil levels were normal. He admitted to the treatment of a "bladder worms" at age 8, and to swimming in fresh water as a child. He was treated with Praziquantil and will be re-scoped in 4 months to once again look for squamous cell carcinoma which is ~15 times more frequent in individuals with S. hematobium infections. (IARC monographs Volume 61 1994)*. Bladder wall ulcers are a frequent finding in chronic S. hematobium infections.
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* International Agency for Research on Cancer, World Health Organization. Volume 61. Schistosomes, Liver Flukes and Helicobacter pylori. 1994
