Magnetic resonance of the liver in acute schistosomiasis

Abstract

A 15-year-old boy developed persistent fever and a diffuse maculopapular rash 21 days before hospital admission [Minas Gerais, Brazil]. He was unresponsive to antibiotic and symptomatic treatment. He was underweight with pale skin. Abdominal palpation showed painful hepatomegaly and splenomegaly. Leukocytosis and eosinophilia were observed. Serum alanine aminotransferase was slightly elevated. Abdominal ultrasound showed liver and spleen enlargement and periportal lymph nodes. Schistosoma mansoni eggs were identified in the faeces. He reported contact with stream water in a schistosomiasis endemic area 30 days before symptoms started. Magnetic resonance (MR) of the liver revealed disseminated hypointense nodules and periportal lymph nodes, suggesting the presence of huge granulomas during the acute phase of hepatic schistosomiasis. This case is thought to be the first description of MR of the liver during acute schistosomiasis.