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Schistosomiasis—A Disobedient Ureter, a Disobedient Diagnosis
Background: Schistosomiasis is rare in western countries, but remains a potentially serious disease. It is known to result in severe urogenital complications; prompt diagnosis can therefore significantly affect outcomes. Case Presentation: We report the case of a 41-year-old male with pleuritic ches...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Mary Ann Liebert, Inc.
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5628567/ https://www.ncbi.nlm.nih.gov/pubmed/29082328 http://dx.doi.org/10.1089/cren.2017.0042 |
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author | Pal, Pallavi Olivia Smith, Richard Daron Allen, Sian Ratynska, Marzena Edwards, Simon Gothard, Philip Logan, Sarah |
author_facet | Pal, Pallavi Olivia Smith, Richard Daron Allen, Sian Ratynska, Marzena Edwards, Simon Gothard, Philip Logan, Sarah |
author_sort | Pal, Pallavi Olivia |
collection | PubMed |
description | Background: Schistosomiasis is rare in western countries, but remains a potentially serious disease. It is known to result in severe urogenital complications; prompt diagnosis can therefore significantly affect outcomes. Case Presentation: We report the case of a 41-year-old male with pleuritic chest pain and visible hematuria who had emigrated from Zimbabwe to the United Kingdom 20 years previously. CT imaging revealed a hydronephrotic right pelvicaliceal system, with a dilated ureter to its distal portion. Preliminary tests for schistosomiasis, including terminal urine microscopy and serology, were negative. An initial ureteroscopy was challenging owing to a tight ureteral stricture such that a retrograde stent insertion and not ureteroscopic visualization or biopsy was carried out. A relook ureteroscopy after 6 weeks revealed a dense distal ureteral stricture, biopsies were taken, the stricture was ablated with LASER, and a retrograde stent was placed. Microscopic examination of the biopsies confirmed Schistosomiasis haematobium. Treatment consisted of a divided dose of praziquantel and a reducing dose of steroids. At a third look ureteroscopy the stricture was ablated with LASER again, and the stent was removed. Subsequent renograms indicated recurrent obstruction despite LASER treatment and a retrograde ureteral stent was replaced. The patient ultimately had a Boari flap ureteral reimplant with good results. Conclusion: This case illustrates the clinical challenges of diagnosing and treating ureteral schistosomiasis. It shows that all the initial tests can be negative, but where the clinical picture points toward schistosomiasis it is worth persevering and a good tissue biopsy may be the only way to verify an otherwise elusive diagnosis. |
format | Online Article Text |
id | pubmed-5628567 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Mary Ann Liebert, Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-56285672017-10-27 Schistosomiasis—A Disobedient Ureter, a Disobedient Diagnosis Pal, Pallavi Olivia Smith, Richard Daron Allen, Sian Ratynska, Marzena Edwards, Simon Gothard, Philip Logan, Sarah J Endourol Case Rep Case Report Background: Schistosomiasis is rare in western countries, but remains a potentially serious disease. It is known to result in severe urogenital complications; prompt diagnosis can therefore significantly affect outcomes. Case Presentation: We report the case of a 41-year-old male with pleuritic chest pain and visible hematuria who had emigrated from Zimbabwe to the United Kingdom 20 years previously. CT imaging revealed a hydronephrotic right pelvicaliceal system, with a dilated ureter to its distal portion. Preliminary tests for schistosomiasis, including terminal urine microscopy and serology, were negative. An initial ureteroscopy was challenging owing to a tight ureteral stricture such that a retrograde stent insertion and not ureteroscopic visualization or biopsy was carried out. A relook ureteroscopy after 6 weeks revealed a dense distal ureteral stricture, biopsies were taken, the stricture was ablated with LASER, and a retrograde stent was placed. Microscopic examination of the biopsies confirmed Schistosomiasis haematobium. Treatment consisted of a divided dose of praziquantel and a reducing dose of steroids. At a third look ureteroscopy the stricture was ablated with LASER again, and the stent was removed. Subsequent renograms indicated recurrent obstruction despite LASER treatment and a retrograde ureteral stent was replaced. The patient ultimately had a Boari flap ureteral reimplant with good results. Conclusion: This case illustrates the clinical challenges of diagnosing and treating ureteral schistosomiasis. It shows that all the initial tests can be negative, but where the clinical picture points toward schistosomiasis it is worth persevering and a good tissue biopsy may be the only way to verify an otherwise elusive diagnosis. Mary Ann Liebert, Inc. 2017-08-01 /pmc/articles/PMC5628567/ /pubmed/29082328 http://dx.doi.org/10.1089/cren.2017.0042 Text en © Pallavi Olivia Pal et al. 2017; Published by Mary Ann Liebert, Inc. This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Case Report Pal, Pallavi Olivia Smith, Richard Daron Allen, Sian Ratynska, Marzena Edwards, Simon Gothard, Philip Logan, Sarah Schistosomiasis—A Disobedient Ureter, a Disobedient Diagnosis |
title | Schistosomiasis—A Disobedient Ureter, a Disobedient Diagnosis |
title_full | Schistosomiasis—A Disobedient Ureter, a Disobedient Diagnosis |
title_fullStr | Schistosomiasis—A Disobedient Ureter, a Disobedient Diagnosis |
title_full_unstemmed | Schistosomiasis—A Disobedient Ureter, a Disobedient Diagnosis |
title_short | Schistosomiasis—A Disobedient Ureter, a Disobedient Diagnosis |
title_sort | schistosomiasis—a disobedient ureter, a disobedient diagnosis |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5628567/ https://www.ncbi.nlm.nih.gov/pubmed/29082328 http://dx.doi.org/10.1089/cren.2017.0042 |
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