We present the case of a 30-year-old male from sub-Saharan Africa with a history of angiodema, no previous surgery and no chronic treatments. He consulted for diarrhoea with mucus and blood for several weeks. Physical examination revealed splenomegaly and non-painful hepatomegaly.
The haemogram showed a haemoglobin of 10.3 g, 53,000 platelets, 3,460 leukocytes, with a normal formula. Liver function showed elevated liver enzymes (GOT 48, GPT 63) and prothrombin activity 53%. On immunochemistry, total IgE was 960 mg (VN < 100).
Peripheral blood smear showed moderate anisocytosis with polysegmentation of neutrophils, with no atypical cells. Serology for hepatotropic viruses, HIV, Toxoplasma, cytomegalovirus, Salmonella, Brucella, hydatidosis, leishmaniasis, fascioliasis and amoebiasis was negative, with the exception of serology for Schistosoma which was positive at a titre of 1/512 (IgG). Stool and urine cultures and stool parasites were negative.
Abdominal ultrasound showed indirect signs of chronic liver disease and a homogeneous splenomegaly of 16 cm, with varicose veins in the splenic hilum. Upper gastrointestinal endoscopy showed grade II/IV varicose veins in the oesophagus and very congestive gastric mucosa in the stomach, especially in the antrum and gastric body, and pseudotumoral varicose veins in the gastric cardia. A colonoscopy was performed, revealing a petechial rectitis with a small polyp measuring 0.6 cm, which was removed. Pathological examination of the rectal biopsies revealed a mixed inflammatory infiltrate with focal abscess formation and a moderate presence of eosinophils, with no noticeable depletion of goblet cells. After multiple sections of the polypoid formation, oval structures of refractive cuticle measuring 150 microns in maximum diameter with massive internal calcification were observed in the submucosa.

With the diagnosis of schistosomiasis with rectal and hepatic involvement, treatment was started with praziquantel at a dose of 50 mg/kg body weight in three doses. The patient improved clinically and analytically, with normalisation of liver function parameters and haemogram. Upper gastrointestinal endoscopy and abdominal ultrasound six months after treatment showed the disappearance of the oesophagogastric varices and the ultrasound signs of chronic liver disease.