[Peranal bleeding and elevated liver function tests in a 33‑year-old refugee from Nigeria].

Area of Science:

• Hepatology
• Infectious Diseases
• Parasitology

Background:

• Schistosomiasis is a parasitic disease caused by flatworms of the Schistosoma genus.
• It is prevalent in tropical and subtropical regions, often associated with freshwater exposure.
• Diagnosis can be challenging, especially in non-endemic areas or with atypical presentations.

Observation:

• A 33-year-old Nigerian refugee in Germany presented with pelvic pain, perianal hemorrhage, and elevated transaminases.
• Initial investigations including liver screening, sonography, and colonoscopy were inconclusive.
• A liver biopsy unexpectedly revealed Schistosoma mansoni eggs, leading to further diagnostic confirmation.

Findings:

• Serological tests confirmed specific antibodies against Schistosoma mansoni.
• Parasitological examination of stool detected Schistosoma mansoni eggs.
• Initial praziquantel treatment at low dose and short duration provided only temporary relief.

Implications:

• Liver biopsy can be crucial for diagnosing schistosomiasis in cases with atypical symptoms and normal initial workup.
• High-dose, prolonged praziquantel treatment may be necessary for effective management of challenging schistosomiasis cases.
• This case highlights the importance of considering parasitic infections in refugees presenting with unexplained symptoms, even in non-endemic countries.