Vesical schistosomiasis, an emerging cause of gross hematuri
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A 7-year-old boy for the last 3 weeks, presented with hypogastric pain and painful hematuria over the past month. His clinic blood pressure was 90/49 mmHg (p28/p25). The physical examination was unremarkable.

Initial laboratory workup revealed hypereosinophilia (1910 cells/mm3) and elevated levels of total serum IgE (332 IU/ml), with normal kidney function and levels of electrolytes and serum complement C3 and C4. Urinalysis showed leukocyturia, hematuria, and proteinuria. Abdominal USG revealed a focal nodular and polypoid thickening of the posterior wall of the bladder. Urinary microscopy revealed Schistosoma haematobium eggs.

His asymptomatic 10-year-old brother was also examined, revealing the same lesions in the ultrasound scan and presence of eggs in the urine. Both were treated with praziquantel, 40 mg/kg/day orally in two divided doses for 1 day. Unfortunately, the patients were lost to follow-up due to an address change.

Sub-Saharan Africa accounts for 93% of the estimated 207 million cases of schistosomiasis worldwide. The highest prevalence is reported in Nigeria, closely followed by the United Republic of Tanzania, Ghana, and Democratic
Republic of Congo. Most cases in Africa are due to S. mansoni, which causes intestinal schistosomiasis, and S. haematobium, which causes urinary schistosomiasis.

S. haematobium eggs cause a granulomatous reaction in the bladder that may progress to calcification and fibrosis, with long-term consequences such as bladder dysfunction, obstructive uropathy, chronic pyelonephritis, and bladder
cancer. Proteinuria is a common feature and usually related to bladder injury.

Asymptomatic children coming from endemic areas should raise suspicions about the disease, since there may be a symptom-free interval between the appearance of bladder injuries and gross hematuria. Diagnosis is simple
through urinary microscopy, which is essential for early treatment and prevention of complications.