25-year-old Egyptian student who had lived in England for the past 2 years presented with acute haematemesis. Examination revealed marked hepatosplenomegaly. Esophageal and gastric varices were identified at emergency upper gastrointestinal endoscopy, thus confirming the presence of portal hypertension. The following disorders were considered in the differential diagnosis as a possible cause of his portal hypertension: alcoholic cirrhosis, chronic active hepatitis, portal and hepatic venous obstruction and schistosomiasis. Alcoholic liver disease was considered unlikely since he was a teetotaller; ultrasound and computed tomography studies of the porta-hepatic circulation excluded vascular obstruction. A liver biopsy was postponed until his deranged clotting was corrected. The patient has marked raised total serum IgE: 2500kU/l (NR <130). Examination of stool specimens revealed the characteristic ova of S. mansoni and high levels of serum antibodies to S. mansoni were subsequently detected by enzyme immunoassay. Endoscopic sclerotherapy was used to sclerose his bleeding varices and he was commenced on Praziquantel, a highly effective antischistosomal drug. Questions for Research: 1. What is your diagnosis here? Support your claim by discussing the differential diagnosis for the disease. 2. What is the cause of his disease and the mode of transmission? 3. What drug, dosage form, schedule, and duration of therapy are best for treating patients with this condition? 4. How can this condition be prevented?
Case:
A 25-year-old Egyptian student who had lived in England for the past 2 years presented with acute haematemesis. Examination revealed marked hepatosplenomegaly. Esophageal and gastric varices were identified at emergency upper gastrointestinal endoscopy, thus confirming the presence of portal hypertension.
The following disorders were considered in the differential diagnosis as a possible cause of his portal hypertension: alcoholic cirrhosis, chronic active hepatitis, portal and hepatic venous obstruction and schistosomiasis.
Alcoholic liver disease was considered unlikely since he was a teetotaller; ultrasound and computed tomography studies of the porta-hepatic circulation excluded vascular obstruction. A liver biopsy was postponed until his deranged clotting was corrected.
The patient has marked raised total serum IgE: 2500kU/l (NR <130). Examination of stool specimens revealed the characteristic ova of S. mansoni and high levels of serum antibodies to S. mansoni were subsequently detected by enzyme immunoassay. Endoscopic sclerotherapy was used to sclerose his bleeding varices and he was commenced on Praziquantel, a highly effective antischistosomal drug.
Questions for Research:
1. What is your diagnosis here? Support your claim by discussing the differential diagnosis for the disease.
2. What is the cause of his disease and the mode of transmission?
3. What drug, dosage form, schedule, and duration of therapy are best for treating patients with this condition?
4. How can this condition be prevented?
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