Schistosomal colitis mimicking inflammatory bowel disease: a case report from Sudan

Schistosomiasis, caused by parasitic Schistosoma species, is a common neglected tropical disease prevalent in sub-Saharan Africa, including Sudan. While urinary tract infections are more frequent, intestinal schistosomiasis is rare. The disease presents with nonspecific symptoms, often leading to misdiagnosis as inflammatory bowel disease (IBD).

A 23-year-old male farmer from Gezira, Sudan, presenting with intermittent bloody diarrhea and mild left lower abdominal pain for 6 months. Despite multiple diagnoses and treatments for dysentery and IBD, his symptoms persisted. Colonoscopy revealed edematous mucosa with scattered whitish spots in the rectum, sigmoid, descending, and transverse colon, with normal findings in the ascending colon and cecum. Biopsies confirmed eosinophilic colitis with schistosomal egg shells. The patient was treated with praziquantel, leading to the resolution of symptoms within 2 weeks.

Schistosomiasis, caused by Schistosoma mansoni, commonly manifests with myalgia, fever, and rash, alongside abdominal symptoms. Diarrhea, abdominal pain, constipation, and weight loss are common. Stool examination and serological tests aid in diagnosis, but colonoscopy can reveal characteristic findings, such as edematous mucosa and schistosomal nodules. Early diagnosis and treatment with praziquantel are essential to prevent complications and improve patient outcomes.

This case emphasizes the importance of considering schistosomiasis in endemic areas when evaluating patients with colitis symptoms. Healthcare providers should maintain a high index of suspicion for this condition, especially in patients with nonspecific gastrointestinal symptoms and a history of travel to endemic areas. Early diagnosis and treatment are crucial to prevent complications and improve outcomes.