1607 The Hidden Parasite

Abstract

INTRODUCTION: Parasite identification during routine colon cancer screening is unexpected and rather unusual. Schistosoma is a tropical parasite associated to freshwater snails; among which S. mansoni and S. japonicum species have been associated with intestinal tract infection. Although most patients are asymptomatic, identification is crucial to avoid possible complications like chronic intestinal schistosomiasis or hepatosplenic schistosomiasis. CASE DESCRIPTION/METHODS: A 57-year-old Puerto Rican Vietnam veteran with history of schizophrenia and chronic liver disease secondary to Hepatitis C underwent colonoscopy for average-risk colorectal cancer screening. During colonoscopy, a one-centimeter polyp at 15cm was completely removed by hot snare and six additional small sessile polyps in the rectum by cold forceps. Pathology was remarkable for a tubular adenoma, while one of the rectal polyps identified a non-necrotizing granuloma suggestive of schistosoma parasite. Patient had shown no GI symptoms or complaints and was treated with Praziquantel. DISCUSSION: Puerto Rico is an endemic area for schistosoma. Schistosomiasis is a chronic parasitic disease with significant cause of morbidity and mortality. Intestinal polyps and dysplasia can arise due to granulomatous inflammation surrounding eggs deposited in the bowel wall. Gastrointestinal manifestations may result in chronic abdominal pain, poor appetite, and diarrhea for which early identification is necessary for treatment even in the asymptomatic setting.