A CASE OF SCHISTOSOMIASIS IN A TRANSPLANT PATIENT IN NON ENDEMIC AREA: AN UNUSUAL PRESENTATION

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A CASE OF SCHISTOSOMIASIS IN A TRANSPLANT PATIENT IN NON ENDEMIC AREA: AN UNUSUAL PRESENTATION

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Co-author 1

Ankur Chaudhary cool_doc_ankur@yahoo.co.in PGIMER Nephrology Chandigarh India *

Co-author 2

Arun Prabhahar arunprabhaharcmc PGIMER Nephrology Chandigarh India -

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Smita Divyaveer divyaveer.ss@gmail.com PGIMER Nephrology Chandigarh India -

Co-author 4

Harbir Kohli kohlihs2009@gmail.com PGIMER Nephrology Chandigarh India -

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Introduction

This case highlights the rare yet peculiar presentation of schistosomiasis in a non endemic area.

Methods

NCCT KUB showed two hyperdense lesions in the bladder ?calculi. A 15-year-old female, resident of Himachal Pradesh, with bilateral vesicoureteral reflux (VUR) since 6 years of age. She underwent bilateral deflux procedure, repeat micturating cystourethrogram (MCU) in 2019 showed persistent grade 1 reflux on left side. Her creatinine levels worsened with time and she was initiated on maintenance hemodialysis in 2022 and transplant workup was initiated. NCCT KUB showed 2 hyperdense lesions in the bladder over right and left posteroinferior wall around the site of deflux injection: bladder calculi were suspected and planned for removal during transplant procedure. Intraoperatively, cystic lesions were found instead of calculi. Histopathological evaluation revealed PAS-positive eggs with lateral spines suggestive of Schistosoma mansoni.

Results

Histopathlogy revealed PAS positive eggs with lateral spines suggestive of Schistosoma mansoni. Post-transplant, she had normal urine output with no symptoms or complications of schistosomiasis. She was initiated on triple immunosuppression with tacrolimus, mycophenolate mofetil and prednisone, along with two doses of 300 mg praziquantel. Since it is not endemic in India and there was no foreign travel history of the patient, the infection was likely imported by tourists who frequent the patient's hometown. Her family members urine was examined for schistosomiasis, which was negative. Plan is to follow up after 3 months with antigen testing and urine for eggs.

Conclusion

This case highlights the importance of considering schistosomiasis as a potential cause of bladder calcifications even in places where the disease is not endemic. Early diagnosis and treatment can prevent long-term complications and improve patient outcomes.

Kewords