Vulva Schistosomiasis Presenting as Chronic Malignant Ulcer in an HIV Patient: A Case Report and a Review of the Literature

Abstract

Schistosomiasis is a freshwater parasitic disease caused by infection with the trematode of the genus Schistosoma. The common species of Schistosoma that affect humans are the Schistosoma haematobium, S. japonicum, and S. mansoni. The clinical manifestations of Schistosoma are determined by causal factors, which include the type of Schistosoma, period of infection, host-specific factors that influence the activity to the worm eggs, and access to treatment. A 51-year-old woman who is a known HIV type 1 positive patient for the past 18years and is on antiretroviral therapy presents to the clinic with a year history of vulva itching. On examination of the vulva is a clean base ulcer that measures 5x3cm with raised edges. Investigation shows normal Full blood count and blood urea nitrogen. Her viral load has decreased from 45,460 in 2018 to 201 viral copies in 2020. The pathologist received a skin wedge biopsy measuring 3.5x2x1.5 cm of greyish white with dark brown areas. Sections of the tissue showed an ulcerated skin with a heavily mixed inflammatory infiltrate mainly of lymphocytes, plasma cells, and eosinophils. A diagnosis of Vulva Schistosomiasis was made. The patient was treated with Praziquantel and the ulcer is healing. It is therefore recommended that there should be adequate distribution of praziquantel in Schistosoma endemic areas to help reduce and prevents schistosomiasis. Again, there should be regular provision of praziquantel living with HIV ( preventive chemotherapy) who stays in Schistosoma endemic areas.