Page 183 - Medical Parasitology_ A Textbook ( PDFDrive )

176 14 Case Reports

bloody stool. On abdominal examination, there was massive splenomegaly without
signs of decompensated liver disease and portal hypertension and she was not in
hepatic encephalopathy state. Her admission blood test showed pancytopenia.
Abdominal ultrasound scan demonstrated appearances of liver cirrhosis with sple-
nomegaly, gastric and splenic varices.
On further questioning the patient said that she lives in Rabak region, Sudan,
where her daily routine are cow rearing and farming. Her sources of drinking water
are from canals and wells, where both are infested with snails. Sanitation is poor
and canals are used as toilets. She said she had been exposed to the snail infested
water for many years. While in Sudan, the patient had a history of contracting
malaria and was treated with intravenous artesunate. Viral screening for hepatitis B
and C was negative. Thick and thin blood films for malaria were negative. Blood
was sent to a diagnostic laboratory for serological tests to rule out leishmaniasis and
schistosomiasis. Leishmaniasis was negative. However, the serological test by
ELISA for schistosomiasis was positive. Schistosoma mansoni eggs were detected
in the stool by Kato-Katz thick smear stool examination confirming the diagnosis of
schistosomiasis. The egg of S. mansoni has a characteristic lateral spine. Following
the diagnosis, the patient was treated with praziquantel 40 mg/kg of body weight in
a single dose and the patient progressed well. Stool examination after anthelminthic
treatment was negative for S. mansoni eggs.

Source: Rajoo, Yamuna, Rohela Mahmud, Ng Rong Xiang, Sharifah FS Omar,
G. Kumar, Yvonne AL Lim, Arine Fadzlun Ahmad, Amirah Amir, Zurainee
Mohamed Nor, and Romano Ngui. “Liver cirrhosis and splenomegaly associated
with Schistosoma mansoni in a Sudanese woman in Malaysia: A case report.”
Asian Pacific Journal of Tropical Medicine 8, no. 4 (2015): 334–6.

Learning Points
1. There are various causes of portal hypertension and one must consider the aetiol-
ogy of schistosomiasis when seeing patients from endemic areas. While schisto-
somiasis is rare in Malaysia, it is one of the commonest causes of portal
hypertension in endemic areas.
2. Other parasitic infections causing splenomegaly include visceral leishmaniasis
and tropical splenomegaly syndrome (TSS), which is caused by malaria.
3. Schistosomiasis remains a significant public health concern in endemic areas.

Case 19: Acute Cholecystitis Caused by Clonorchis sinensis
Case report: A 43-year-old Chinese man from Hong Kong, presented with an acute
onset of severe upper abdominal pain. On admission, an ultrasound scan showed
nodular lesions in the gallbladder and an enlarged dilated gallbladder which was
consistent with acute cholecystitis. His liver function test was normal and he had no
clinical jaundice. On the second day, he developed jaundice and the pain became
much worse. The patient underwent emergency cholecystectomy the same night,
and the liver was noted to be congested and friable, with features of fatty liver. The
gallbladder was tense, dilated, and edematous. On exploration of the common bile