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Interesting case of right iliac fossa pain in a UK patient
EP30566
Poster Title: Interesting case of right iliac fossa pain in a UK patient
Submitted on 11 Sep 2019
Author(s): Dr K Shahzad, Mr I Peristerakis, Dr M Pitt, Dr S Mathew
Affiliations: Royal Preston Hospital, UK
This poster was presented at BIR Annual Congress 2019
Poster Views: 167
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Poster Information
Abstract: Interesting case of right iliac fossa pain in a UK patient

Introduction:
Schistosoma is a blood fluke which is second only to malaria in terms of worldwide prevalence with the biggest disease burden in Africa. Considering western countries, it is an extremely rare disease in the US and relatively rare with only a few hundred cases reported in Europe involving mainly immigrants, refugees and tourists. According to our knowledge, there are no published reports of intestinal Schistosoma infection in a UK patient.

Imaging findings:
A 62 years old male presented to us with 3 months history of worsening right iliac fossa pain. He had significant travel history including travel to Africa. Initial CT showed caecal and distal ascending colonic thickening with pericaecal fluid raising the possibility of appendicitis. However, colonic tumor could not be excluded. Subsequent colonoscopy and biopsies from caecum and ascending colon showed submucosal granulomas with features suggestive of schistosomiasis. He was treated with appropriate medical therapy with complete serological recovery. Follow-up CT after treatment showed improvement in colonic thickening and peri-colonic inflammatory changes.

Conclusion:
With increasing immigration and travel for work, social and pleasure reasons, there is a chance of patients contracting schistosomiasis abroad and bringing it back to the UK. We present first case report of a patient with intestinal schistosomiasis presenting in the UK and anticipate that there may be few more cases in future. Early diagnosis is important as schistosomiasis can be relatively easily and cheaply treated with Praziquantel whilst delayed or non-treatment could lead to long term sequale from chronic illness.
Summary: Learning Point:
This case is intended to highlight a disease process which may become more frequent in patients presenting in the UK hospitals due to immigration from and travel to endemic areas. We therefore urge Clinicians to seek appropriate travel history in all patients.
References: 1) Faculty of Medicine ICL. Schistosomiasis [Web page]. Imperial College London web page: Imperial College London; [cited 2019]. Available from: https://www.imperial.ac.uk/schistosomiasis-control-initiative/our-work/what-we-do/schistosomiasis/.
2) Lopez de Cenarruzabeitia I, Landolfi S, Armengol Carrasco M. Intestinal schistosomiasis as unusual aetiology for acute appendicitis, nowadays a rising disease in Western countries. Case reports in infectious diseases. 2012;2012:896820.
3) Elbaz T, Esmat G. Hepatic and intestinal schistosomiasis: review. Journal of advanced research. 2013;4(5):445-52.
4) Organization WHO. Schistosomiasis. 20/02/2018 ed: World Health Organization; 2018.
5) Gray DJ, Ross AG, Li YS, McManus DP. Diagnosis and management of schistosomiasis. BMJ. 2011;342:d2651.
6) Shuja A, Guan J, Harris C, Alkhasawneh A, Malespin M, De Melo S. Intestinal Schistosomiasis: A Rare Cause of Abdominal Pain and Weight loss. Cureus. 2018;10(1):e2086.
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