# Bleeding rectal polyp as an atypical presentation of intestinal schistosomiasis: A case report from Egypt

## TL;DR

A rare case of intestinal schistosomiasis in Egypt presented as a bleeding rectal polyp, highlighting the need for histopathological diagnosis to avoid misdiagnosis.

## Contribution

This case report presents an atypical manifestation of schistosomiasis as a solitary rectal polyp, emphasizing the importance of histopathology in diagnosis.

## Key findings

- A 28-year-old Egyptian male presented with a solitary rectal polyp that was later diagnosed as schistosomiasis.
- Stool tests were negative, but histopathology revealed Schistosoma mansoni ova and an adult worm.
- The case underscores the need to consider schistosomiasis in the differential diagnosis of rectal polyps in endemic regions.

## Abstract

Schistosomiasis remains an important public health challenge in Egypt despite decades of control programs. Intestinal involvement is relatively common but usually presents with diffuse mucosal disease, ulcerations, or multiple polyps. A solitary bleeding rectal polyp as the sole manifestation is exceedingly rare and can be mistaken for inflammatory bowel disease or colorectal neoplasia. This report aims to highlight this diagnostic challenge within the Egyptian context.

A 28-year-old Egyptian male from a rural area presented with a 3-month history of intermittent lower abdominal pain and rectal bleeding. Physical examination was unremarkable except for mild lower abdominal tenderness and blood on digital rectal exam. Laboratory tests, including inflammatory markers, were normal; notably, stool microscopy was repeatedly negative for schistosome ova, despite the presence of RBCs and WBCs. Colonoscopy identified a solitary, pedunculated, and ulcerated rectal polyp (1.5 × 3.0 cm) at 20 cm from the anal verge, which was completely resected. Histopathological examination confirmed the diagnosis by demonstrating viable Schistosoma mansoni ova within eosinophilic granulomas and, critically, an adult worm residing in the submucosal vasculature, confirming active infection.The patient achieved full clinical recovery after praziquantel therapy, and this case underscores the importance of integrating parasitological, endoscopic, and histopathological perspectives when managing atypical colorectal lesions in endemic regions.

This case is a striking example of intestinal schistosomiasis masquerading as a sporadic colorectal neoplasm. In endemic regions like Egypt, schistosomiasis must be considered in the differential diagnosis of solitary rectal polyps, even with negative stool examinations. The definitive diagnosis hinges on histopathological analysis, which is indispensable for guiding correct management and avoiding unnecessary interventions. This report reinforces the ongoing, evolving challenge of schistosomiasis in Egypt post-control programs.

Schistosomiasis remains a health problem in Egypt, even after years of control programs. While intestinal schistosomiasis often causes widespread inflammation, we report a very unusual case where it appeared as a single bleeding polyp in the rectum, looking just like a tumor or inflammatory bowel disease. This 28-year-old man had rectal bleeding and abdominal pain, but standard stool tests failed to detect the parasite. Only after removing the polyp during colonoscopy and examining it under the microscope was the diagnosis clear: the tissue contained both schistosome eggs and an adult worm. This case teaches us that in regions where schistosomiasis still occurs, doctors must consider this infection even when tests are negative and the presentation is misleading. Pathological examination is key to correct diagnosis and avoiding unnecessary treatments. Our report emphasizes that as classic schistosomiasis becomes rarer, unusual forms may become more common, requiring updated clinical awareness.