In November 2008, an 8-year-old Brazilian girl, living in Italy since 2006, came to our department with persistent diarrhoea. Some months before, the girl was admitted to another hospital due to fever, asthenia and weight loss that started 1 month after a holiday in Brazil. During the previous recovery, diagnosis of pulmonary tuberculosis was posed according to chest x-ray image showing a diffuse ground glass pattern () and positive enzyme-linked-immunospot assay. Even though no identification of Mycobacterium tuberculosis was provided by gastric aspirate, broncholavage fluid and Mantoux test, the patient received antitubercular therapy. On admission to our department, a first clinical assessment underlined cervical and groin-related lymphadenitis with important hepatomegaly then confirmed by ultrasound echography. Blood tests showed microcytic anaemia, hypereosinophilia and general phlogosis. Celiac screen and angiotensin converting enzyme tests were negative. Stool exams for bacterial, viral or parasitic infections also proved negative. No signs or symptoms of urinary tract dysfunction were present and renal function was normal in both girls. Stool exam was required for a mild persistent diarrhoea in the younger sister and, finally, eggs of Schistosoma mansoni were detected through direct microscopic examination of the specimen. According to this result, S mansoni antibodies were evaluated using an indirect haemagglutination assay (Cellognost-Schistosomiasis H, Behring, Germany), and high levels (256 and 512 in the younger and elder sister, respectively; level cut-off <16) were detected in both girls. Treatment with praziquantel was started at 40 mg/kg/die. Fever, diarrhoea and abdominal pain appeared as common symptoms after the first dose and abated in a few hours after oral antihistaminic and intravenous steroids were administered.
First chest x-ray scan, showing diffuse ground glass pattern image.