A case of old schistosomiasis japonicum presented with acute appendicitis

Abstract

A 75-year-old man who visited the hospital because of right lower abdominal pain in May 2006 showed remarkably elevated levels of white blood cell counts and CRP in blood examinations. Abdominal CT scan disclosed a tumor shadow with calcification, so that an emergency operation was performed with a diagnosis of acute appendicitis. Laparotomy disclosed a swollen appendix and appendectomy was carried out. The histopathological diagnosis was phlegmonous appendicitis. Degenerated and calcified ova of Schistosoma japonicum were present from the submucosal to subserosal structures, which were considered to be findings of old glanuloma. Postoperative stool examinations for ova and parasites revealed no abnormal findings. The anti-worm body and anti-egg antibodies were negative on ELISA method. Thus old schistosomiasis japonicum was diagnosed and no parasiticide was given to the patient.
As far as we could review the literature from the ichushi web, a total of 19 cases of appendicitis with old schistosomiasis japonicum have been reported in Japan from 1980 to 2006. No new patient with the disease has appeared in this country after 1978 when the last case had been reported. However, some imported cases as well as old cases are reported. We must remain alert for the disease in our daily clinical practice.