Clinical review for general practice

Background. Schistosomiasis is a parasitic infection with hepatobiliary involvement that may mimic autoimmune and chronic liver disease. Its clinical presentation can overlap with conditions such as autoimmune hepatitis and primary biliary cholangitis, particularly in individuals from endemic regions. Diagnosis often requires integration of serology, imaging, and histopathology. We report a case of hepatic schistosomiasis in a middle-aged male presenting with chronic right upper quadrant pain and confounding autoimmune serologies.

Case presentation. A 42-year-old male with no significant past medical or surgical history presented on April 25, 2025, with intermittent nocturnal right upper quadrant (RUQ) abdominal pain and reduced appetite. Initial labs showed preserved liver function (ALT 29 U/L, AST 28 U/L, ALP 84 U/L, total bilirubin 11.4 µmol/L), normal inflammatory markers (CRP 1.7 mg/L), and positive Schistosoma IgG (ELISA assay). Autoimmune workup revealed positive AMA-M2 (33.4 R units) and ASMA (31 R units), with borderline ANA (1:100). Abdominal ultrasound and FibroScan (11.3 kPa) suggested fibrosis; MRI on May 1, 2025, showed irregular liver margins without focal lesions. Stool ova and parasite exam was negative. Liver biopsy on June 23, 2025, confirmed hepatic schistosomiasis with mild chronic portal inflammation. The patient was referred to infectious disease for antiparasitic therapy on July 3, 2025.

Conclusion. This case highlights hepatic schistosomiasis presenting with overlapping autoimmune markers, creating diagnostic complexity. In patients from endemic areas, parasitic infection should remain a differential diagnosis even in the presence of autoimmune antibodies. Long-term follow-up is warranted to monitor for autoimmune overlap and progression of hepatic fibrosis.

Keywords: hepatic schistosomiasis, autoimmune markers, right upper quadrant pain, liver fibrosis, liver biopsy.

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