Una macroematuria “esotica”

A 6-year-old boy from Burkina presented gross hematuria and dysuria for 2 weeks. A history of recurrent dysuria started in Africa during the past 2 months. The patient’s history disclosed that he used to bath and swim in a pool of his rural village in Burkina. Physical exam was normal. Urine dipstick demonstrated hematuria, leukocyturia and proteinuria; the urine sediment showed a large number of leukocytes (eosinophils), isomorphic erythrocytes and several ovoid shaped elements with terminal spine and internal granules which could easily be identified as Schistosoma haematobium eggs. We also noted a well-preserved miracidium which showed active movements. Urinary tract ultrasound revealed some focal areas of thickening of the bladder wall. The urinary schistosomiasis was successfully treated by oral administration of praziquantel (single dose 40 mg/kg) with normalization of urine sediment after a week. Schistosoma haematobium is a major cause of urinary tract disease in many african areas. Since there is an increasing flow of immigrants towards Italy as well as tourists from endemic areas, it is important for Italian clinicians to be familiar with this traditionally exotic disease. The diagnosis is simple if suspected, and an effective and safe treatment is available.