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A Case of Tubal Schistosomiasis presenting as a Ruptured Ectopic Gestation

Dineth Adrienne C. Gutierrez, Mary Johnston Hospital, Philippines

Schistosomiasis is a tropical disease caused by parasitic flatworms of the genus Schistosoma that enter the human body through the skin. The different species of these schistosomes have predilections for specific organs in the body, and signs and symptoms depend on which areas are affected. Cases of Schistosomiasis of the female reproductive tract are rare but have been seen in areas of the world where Schistosoma haematobium, in particular, is endemic. When Schistosomiasis involves the fallopian tubes, it produces fibrotic scars and tubal occlusion, leading to infertility and ectopic pregnancy. A thorough literature search has revealed no reported local case of tubal Schistosomiasis to date. Furthermore, the only Schistosoma species that has been found in the Philippines is Schistosoma japonicum, while the species most often isolated in tubal Schistosomiasis, in contrast, is Schistosoma haematobium. A case of a 32-year-old primigravid from Northern Samar, with amenorrhea of 8 weeks and 5 days, who presented with vaginal spotting and hypogastric pain is hereby reported. She underwent salpingostomy for ectopic pregnancy and was later, upon histopathological examination, found to have tubal infection by Schistosoma, which was treated with Praziquantel. This case is note-worthy because of the following reasons: a) no local case reports on tubal Schistosomiasis are currently available based on literature search; b) Schistosoma haematobium, the major species implicated in Schistosoma infection of the fallopian tube, is not found in the Philippines; and c) the finding of Schistosomiasis concomitant with a tubal pregnancy in a previously asymptomatic patient is quite rare. This case report highlights tubal Schistosomiasis, despite its rarity in the Philippines, as a significant risk factor for ectopic pregnancy. Knowledge on this disease and a high index of suspicion is important in managing affected patients.