Intestinal Schistosomiasis in an Adolescent with Freshwater Exposure in Somalia: A Case Report

Introduction : Schistosomiasis remains a significant public health burden in Somalia, particularly in riverine and agricultural areas where contact with cercariae-infested water is common. Despite mass drug administration (MDA) campaigns, clinical case reports are rarely documented, limiting insights into real-world presentations and diagnostics in endemic settings. This case highlights the clinical and diagnostic approach to intestinal schistosomiasis in a Somali adolescent. Case Presentation : A 15-year-old male from an agricultural community near Mogadishu presented with a five-month history of crampy abdominal pain and blood-streaked stool. His history revealed frequent swimming and fishing in local irrigation canals. Physical examination was notable only for mild right upper quadrant tenderness. Laboratory findings demonstrated eosinophilia (0.8 × 10⁹/L). Stool microscopy via Kato-Katz technique confirmed Schistosoma mansoni infection with visible lateral-spined eggs. A point-of-care circulating cathodic antigen (POC-CCA) test was additionally positive. Abdominal ultrasonography showed no evidence of hepatosplenic morbidity. The patient was treated with praziquantel (40 mg/kg), resulting in complete resolution of symptoms within two weeks. Follow-up at six weeks confirmed parasitological clearance. Conclusion : This case underscores the importance of clinical suspicion for schistosomiasis in patients with abdominal pain and hematochezia in endemic areas, even in the absence of advanced disease. It reinforces the value of combined diagnostic tools—microscopy, serological antigen testing, and ultrasound—in resource-limited settings. Furthermore, it emphasizes that individual case management and health education remain crucial complements to community-wide MDA programs for achieving sustained control of schistosomiasis.