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Schistosomiasis japonicum diagnosed on liver biopsy in a patient with hepatitis B co-infection: a case report

Parris, Victoria, Michie, Kirsten, Andrews, Tim, Nsutebu, Emmanuel F, Squire, Bertie ORCID:, Miller, Alastair RO and Beadsworth, Mike BJ (2014) 'Schistosomiasis japonicum diagnosed on liver biopsy in a patient with hepatitis B co-infection: a case report'. Journal of Medical Case Reports, Vol 8, e45.

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Chronic hepatitis B virus and schistosomiasis are independently associated with significant mortality and morbidity worldwide. Despite much geographic overlap between these conditions and no reason why co-infection should not exist, we present what is, to the best of our knowledge, the first published report of a proven histological diagnosis of hepatic Schistosomiasis japonicum and chronic hepatitis B co-infection. A single case of hepatitis B and hepatic Schistosomiasis mansoni diagnosed by liver biopsy has previously been reported in the literature.

Case presentation

A 38-year-old Chinese man with known chronic hepatitis B virus infection presented with malaise, nausea and headache. Blood tests revealed increased transaminases and serology in keeping with hepatitis B virus e-antigen seroconversion. A liver biopsy was performed because some investigations, particularly transient elastography, suggested cirrhosis. Two schistosome ova were seen on liver histology, identified as S. japonicum, probably acquired in China as a youth. His peripheral eosinophil count was normal, schistosomal serology and stool microscopy for ova, cysts and parasites were negative.


Hepatic schistosomiasis co-infection should be considered in patients with hepatitis B virus infection who are from countries endemic for schistosomiasis. Screening for schistosomiasis using a peripheral eosinophil count, schistosomal serology and stool microscopy may be negative despite infection, therefore presumptive treatment could be considered. Transient elastography should not be used to assess liver fibrosis during acute flares of viral hepatitis because readings are falsely elevated. The impact of hepatic schistosomiasis on the sensitivity and specificity of transient elastography measurement for the assessment of hepatitis B is as yet unknown.

Item Type: Article
Additional Information: The electronic version of this article is the complete one and can be found online at:
Subjects: QY Clinical Pathology > Diagnostic Tests > QY 140 Liver tests
WC Communicable Diseases > Virus Diseases > Viral Hemorrhagic Fevers. Other Virus Diseases > WC 536 Human viral hepatitis
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 810 Schistosomiasis
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):
Depositing User: Lynn Roberts-Maloney
Date Deposited: 29 Apr 2015 15:10
Last Modified: 13 Nov 2019 11:22


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