Chronic Hepatitis B with an Unexpected Coinfection

Schistosomiasis and hepatitis B are both tropical diseases with more than 200 and 350 million people infected worldwide respectively, but are rare in western countries. Worldwide a high rate of coinfections can be expected. A 34-year-old African patient was referred to our clinic with known hepatitis B/D-coinfection for evaluation of antiviral treatment. Surprisingly, liver biopsy showed a granuloma with the egg of Schistosoma in addition to virus induced alterations. Subsequent examination of the stool allowed to classify the parasite as Schistosoma mansoni. Thus, before initiation of an antiviral treatment, an antischistosomal therapy with praziquantel leading to elimination of schistosomiasis was started. Patients from tropical countries suffering from chronic viral hepatitis may present with additional coinfections which can be earily overlooked in daily clinical routine. Screening of African patients from endemic areas for schistosomiasis should include examinations for tropical diseases by specialists.