She had no past medical, surgical, or drug history. Her menstrual cycle was regular and previous

cervical smears normal. Her hormone profile and hysterosalpingogram were normal. Two weeks following the hysterosalpingogram she presented with a 3-day history of intermenstrual bleeding and lower abdominal pain. On examination she had supra-pubic tenderness associated with cervical excitation and bleeding from the cervical os. Full blood count, including eosinophil count, was normal. A subsequent laparoscopy demonstrated pelvic adhesions affecting both fallopian tubes; the left Fallopian tube was distended with a semi-solid partially calcified material. Histopathology showed the fallopian tube wall to be grossly expanded by granulomas. Areas of inflammation appeared acutely eosinophilic with eosinophil degranulation Dabrafenib and necrosis.

Schistosoma haematobium were seen and schistosomal enzyme immunoassay was positive. She was treated with praziquantel. The patient had traveled extensively 8–9 years previously, including to Egypt and East Africa, where she swam in Lake Malawi. She had had no post-travel screening for tropical infections. GSK2126458 manufacturer Devastating cases such as these are rare but genital tract disease has been well recognized, particularly in endemic areas, since the first case of vaginal schistosomiasis was described in 1899.1,2 Both sexes can develop genital tract pathologies, but the prevalence is significantly higher in women.3 Infection of the genital tract is most commonly caused by the S. haematobium species and is largely localized to the vagina and cervix, but can affect

any part of the female reproductive tract due to the close proximity of genital venous plexi, which allows easy parasitic migration.2,4 Local genital infection can remain asymptomatic or can present in a variety of ways including: pruritis, swelling, ulceration, wart-like growths, sandy patches, fistulae, discharge, disturbed menstruation, postcoital bleeding, dyspareunia, infertility, fetal loss, or pelvic AZD9291 inflammatory disease.3,5 Cervical neoplasia has also been identified as a long-term complication of genital schistosomiasis.2,6 Other sequalae of ectopic schistosomiasis include appendicitis, pulmonary, and spinal-cord disease. With increasing migration and travel, such presentations will present more commonly in the developed world. The World Health Organization currently advises that post-travel screening is unnecessary for short-term travelers who have not experienced health problems or have had only trivial, self-limiting symptoms, but recommends that travelers should be advised to seek advice if they consider that they have been exposed to a serious infectious disease.7 Swimming in Lake Malawi appears to represent a substantial risk for acquiring schistosomiasis. Cetron and colleagues estimated the risk to be 70% for an exposure of 1 day, increasing to 88% for a 10-day exposure.