Tortuous Varicosities in Chronic Schistosomiasis

A 34-year-old Brazilian man presented with a 24-year history of prominent, progressively dilating superficial veins. The veins of the lower limbs dilated first, gradually becoming discolored and indurated (Panel A). After 5 years, varicosities appeared on the anterior chest and abdominal wall (Panel B). Gynecomastia, splenomegaly, and bilateral varicoceles also developed. Jaundice, spider angiomata, and testicular atrophy were not seen. There was no evidence of liver failure; however, a platelet count of 20,000 per cubic millimeter indicated thrombocytopenia. Duplex Doppler ultrasonography of the abdomen showed periportal fibrosis, splenomegaly, and high portal flow. Esophagogastroduodenoscopy confirmed the presence of esophageal varices. Viable eggs of Schistosoma mansoni were found in stool specimens, which confirmed the diagnosis of intestinal schistosomiasis leading to portal hypertension and splenic sequestration. He was treated with praziquantel and cleared the S. mansoni infection. Despite evidence of profound portal hypertension, he has done well. More than 200 million people worldwide are infected with schistosomes. Of these, approximately 120 million have symptoms and 20 million are severely ill. During the past decade, targeted interventions combining snail control, improved water quality, and the treatment of infected persons have contributed to diminishing the burden of disease.

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