Hosny K, Luk A
Urology Department, Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust , Blackburn , UK.
Ann R Coll Surg Engl. 2018 Jul;100(6):e145-e146. doi: 10.1308/rcsann.2018.0072.
Schistosoma haematobium is the species primarily responsible for the manifestation of schistosomiasis in the genitourinary tract. It is a parasitic disease caused by flukes (trematodes) of the genus Schistosoma, which can result in acute and chronic manifestation. We report a case of urinary schistosomiasis that initially presented as advanced bladder cancer with pulmonary metastasis on initial computed tomography scan. Further investigations revealed no cancer and pulmonary changes resolved with treatment. The involvement of bladder is the hallmark of S. haematobium infection and it is unusual to have pulmonary manifestation without concurrent hepatosplenic disease. Within the lungs, deposition of Schistosoma eggs causes a granulomatous reaction, typically producing miliary nodules on chest radiographs. In our case, this was interpreted initially as lung metastases. However, given the cystoscopic findings and subsequent resolution with praziquantel, this was proved otherwise. This case highlights the importance of urinary cytology in the initial investigation of haematuria. Clinicians should be aware of such a potential differential diagnosis, especially in patients with prior travel history to endemic areas.
埃及血吸虫是导致泌尿生殖道血吸虫病表现的主要病原体。它是一种由血吸虫属吸虫（吸虫纲）引起的寄生虫病，可导致急性和慢性表现。我们报告一例泌尿血吸虫病病例，最初在初次计算机断层扫描时表现为晚期膀胱癌伴肺转移。进一步检查未发现癌症，肺部病变经治疗后消退。膀胱受累是埃及血吸虫感染的标志，没有并发肝脾疾病而出现肺部表现是不常见的。在肺部，血吸虫卵的沉积会引起肉芽肿反应，通常在胸部X光片上产生粟粒状结节。在我们的病例中，最初被解释为肺转移。然而，鉴于膀胱镜检查结果以及随后吡喹酮治疗后的消退情况，事实并非如此。该病例突出了尿液细胞学在血尿初步检查中的重要性。临床医生应意识到这种潜在的鉴别诊断，特别是对于有疫区旅行史的患者。
