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Lindsey R. Baden, M.D., Editor

A Child with Gross Hematuria

previously healthy 8-year-old boy presented with 2 weeks of Lakshmi Ganapathi, M.B., B.S.
recurrent terminal gross hematuria. Two years earlier, after he had been Michael Somers, M.D.
swimming near an irrigation dam in Ghana, painless terminal hematuria Boston Childrens Hospital
developed, which subsequently resolved. Urinalysis revealed microscopic hematuria Boston, MA
with a red-cell count of more than 250 per cubic millimeter (normal range, 0 to 5). lakshmi.ganapathi@childrens.harvard.edu
Urine microscopy revealed oval eggs (approximately 110 to 170 m in length by
50 to 70 m in width) with a terminal spine and transparent shell that were characteristic of Schistosoma haematobium. Miracidia, free-swimming larvae (approximately 200 m in length) that are usually found in environmental water (e.g., lakes and
video showing
rivers), were also seen (see video). S. haematobium is endemic in freshwater bodies Aa miracidium
in many areas of sub-Saharan Africa, and infection can occur after swimming in is available at
this water. Urinary schistosomiasis occurs after the release of eggs by adult worms NEJM.org
living in the bladder and pelvic venous plexus. Eggs penetrate the bladder wall and
ureters, causing granulomas and fibrotic nodules that lead to hematuria and
chronic inflammation. Left untreated, urinary schistosomiasis can cause ureteric
obstruction, secondary urinary tract infections, squamous-cell carcinoma of the
bladder, and ultimately, renal failure. The patient received praziquantel, with resolution of hematuria and clearance of eggs and miracidia at follow-up 8 weeks later.

DOI: 10.1056/NEJMicm1410250
Copyright 2015 Massachusetts Medical Society.

n engl j med 373;9

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August 27, 2015

The New England Journal of Medicine

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