disseminated peritoneal shistosomiasis and primary infertility

Patient name: classified
Age 27 yrs.
Married 6yrs
Nulliparous
A 27 yr. old African women presented with history of primary infertility for 6 years, no history of generalized or lower abdominal pains nausea or vomiting. She reported menarche to have started at age of 16 with regular menstrual cycles of significance was that her flow was light since 2018. Upon evaluation for fertility thyroid function tests were within normal, prolactin-13.05, semen analysis for husband- normozoospermia, hemogram was elevated monocytes 11.8 % and eosinophilia of 15.8%.
Ultrasound pelvis- normal pelvic ultrasound, hysterosalpingography revealed normal triangular shaped uterus, no irregularities or filling defects, no visualization of fallopian tube on the right and ill defined fallopian tube seen on the left with no peritoneal spillage seen on either sides hence suggestive of non-patent fallopian tubes.
Hence an option of diagnostic hysteroscopy + laparoscopy +- tuboplasty was give and an alternative of invitro fertilization was given. Patient opted for diagnostic hysteroscopy + laparoscopy
Hysteroscopy findings – normal uterine cavity, left ostia visible but right ostia blocked not visible. No endometrial masses, scarring, calcifications, or lesions noted.
Laparoscopic findings -multiple whitish peritoneal nodules noted covering the pelvic peritoneal surface.
Histology report from obliterated umbilical artery, bladder left Para tubal biopsies showed fibro adipocytic connective tissue with extensive necrotic and calcifying granulomas with focal remnant inflammatory cells (lymphocytes plasma cells neutrophils and eosinophils). There are numerous calcifying oval parasitic eggs with sharp terminals in all the samples examined in around the necrotic granuloma characteristics of Disseminated (peritoneal) schistosomiasis. Stains for bacterial, fungal, and acid-fast organisms were all negative.
Post-operative urinalysis recommended showed leucocytes +, wbc of 2-4 hpf, Schistosoma eggs absent.

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