Haematobium schistosomiasis presenting in the Netherlands as a skin disease

A rare case is reported of extragenital skin schistosomiasis as the presenting symptom in a 24-year-old Dutch student, who had swum some months earlier in Lake Malawi in Mozambique. Grouped papules dorsolateral on the lower thorax were shown by biopsy to be due to infection by Schistosoma haematobium. The eggs were viable and surrounded by necrosis and partly purulent, partly granulomatous dermatitis that also affected hair follicles. The second biopsy, taken 2.5 months after treatment with praziquantel, still showed viable eggs and necrosis but no more microabscesses. In the third biopsy 5 weeks after a second praziquantel treatment, no eggs were found, but a partly granulomatous abscess forming inflammation affecting a hair follicle was still present.