A young woman of Arabic/North African descent who had moved to Germany presented with hyper-/dysmenorrhea and secondary sterility. Endometriosis was suspected, and swelling of the appendix was observed during operation. Histopathology showed endometriosis in the subserosal tissue and a granular inflammation with increased eosinophils and calcifications. Further examination also revealed schistosomas, most likely Schistosoma mansoni. The unexpected diagnosis is thus endometriosis with concomitant schistosomiasis/bilharziasis. A negative stool sample was obtained after praziquantel therapy. The parasite–host cycle consists of several stages (egg, larva, mature worm) in water and in the bodies of water snails. Free-swimming aquatic Cercariae that swim in water can penetrate human skin and enter the bloodstream to infiltrate the liver. Mature worms that enter the intestines (S. mansoni, S. japonicum) or bladder (S. haematobium) can release their eggs into the environment. Schistosomiasis is very rare in Germany but endemic in Africa, the Middle East, and parts of Asia and South America.
Translated from the original German by Christine Rye.
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Footnotes
Conflict of interest statement: The authors declare that no conflict of interest exists.