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A 15-year-old boy developed persistent fever and a diffuse maculopapular rash 21 days before admission to hospital. He was treated with antibiotics and symptomatic drugs without improvement. Clinical examination revealed a well developed underweight teenager, with pale skin. His axillary temperature was 39.3oC. There was no history of diarrhea. Abdominal palpation showed painful hepatomegaly and splenomegaly. Leukocytosis (38,000 cels/mL) and eosinophilia (30,400 cels/mL) was found in a routine blood count. Platelet counts and hemoglobin levels were within the normal range and serum alanine aminotransferase was slightly elevated. Abdominal ultrasound showed liver and spleen enlargement and periportal lymph nodes. Schistosoma mansoni eggs were described in the stools. He reported contact with stream water in an endemic area for schistosomiasis 30 days before the start of symptoms. Magnetic resonance of the liver disclosed disseminated hypointense nodules (Figure A: T1 weighted imaging after intravenous gadolinium injection – black arrows) and periportal lymph nodes (Figure B: a T2 weighted imaging with a periportal lymph node – white arrow). These findings suggest the presence of huge granulomas of the acute phase of schistosomiasis mansoni in the liver. To our knowledge, this is the first description of MR of the liver in acute schistosomiasis.

Magnetic resonance of the liver in acute schistosomiasis