Hepatic Schistosomiasis: An Overlooked Diagnosis in Non-endemic Regions

Schistosomiasis, caused by trematodes of the genus Schistosoma, is one of the most frequent parasitic infections worldwide. Schistosoma mansoni and Schistosoma japonicum are responsible for most hepatosplenic schistosomiasis cases, infections culminating in granulomatous inflammation, portal fibrosis, and portal hypertension. Definitive diagnosis requires detecting schistosome eggs in stool or biopsy samples, as anti-schistosomal antibodies cannot differentiate active from past infections. Treatment involves a single dose of praziquantel (40 mg/kg) administered orally. Here, we report a young male patient from an endemic region, presenting as incidentally detected mild but persistent transaminitis, who, upon evaluation, was diagnosed with hepatic schistosomiasis with portal fibrosis and portal hypertension. Although he had a low titer positive serology for anti-smooth muscle antibodies (ASMA), the diagnosis of autoimmune hepatitis (AIH) was excluded with a liver biopsy. The case underscores the importance of considering schistosomiasis in unexplained liver disease among patients from or traveled to endemic regions, emphasizing the need for a high clinical suspicion to optimize timely diagnosis and intervention.