Challenges in the diagnostic of bilharziasis: a case report

Bilharziasis is characterized by a localized mass of fibrous, inflammatory tissue that usually contains numerous eggs and often involves the serosa and mesentery. It often raises the issue of differential diagnosis with neoplastic processes. We report the case of a 12-year-old child with a rectal bilharziasis.

We report the case of a 12-year-old child and black ethnicity with no medical history, who was referred by his parents for treatment of rectal discharge lasting 5 months. Physical examination revealed an irregular rectal mass, which was confirmed by colonoscopy. Histological examination revealed schistosoma eggs within a granulomatous reaction. A diagnosis of rectal bilharziasis was made, and surgery was initially proposed. However, when the parents refused, the patient was treated solely with praziquantel (40 mg/kg), which led to the discharge regressing.

Bilharzia is a parasitic disease caused by haematophagous trematodes of the Schistosomatidae family. It particularly affects poor populations living in unfavorable socioeconomic conditions. School-age children are particularly vulnerable when swimming or fishing in infected freshwater. Our patient lives in a rural area with very unfavorable socioeconomic conditions and a high risk of infestation due to promiscuity and a lack of proper drinking water.

Bilharziasis presents as inflammatory pseudotumors, which often raises the issue of differential diagnosis with neoplastic processes.