A (panels A-D), Sequential pictures of contrast-enhanced CT scans. Panels A and B, CT scan at admission showing an important bladder thickening with a vesico-prostatic mass. C, CT scan after corticosteroid therapy: partial regression of prostate lesion but persistence of bladder infiltration. D, CT scan 2 months after antiparasitic treatment showing decreased prostate lesion and reduced peri-vesical infiltration. Panel E, Plain abdominal x-ray with absent "porcelain bladder" aspect. B, Pathological aspects of prostatic biopsies. First biopsy (A-D). A and B, Hematoxylin and eosin-stained sections showing an inflammatory infiltrate rich in eosinophils, plasma cells, and neutrophils. C and D, Immunohistochemical CD138 staining and IgG4 stainings showing increased IgG4+ plasma cells meeting histological criteria for IgG4-RD. Second biopsy (E and F). Hematoxylin and eosin-stained sections revealing viable schistosome eggs (black arrows). Abbreviations: CT, computed tomography; IgG4-RD, IgG4-related disease.

Contexts in source publication

Context 1

... was no fever, night sweats, diarrhea, or hematuria. An abdominal computed tomography (CT) scan revealed a voluminous contrast-enhanced prostatic lesion with necrotic appearance and contiguous bladder extension, as well as left latero-aortic enlarged lymph nodes ( Figure 1A, panels A and B). The vesico-prostatic lesion was responsible for hydronephrosis requiring emergency urinary bypass with nephrostomy. ...

Context 2

... showed a large vesico-prostatic mass. Transurethral bladder biopsy performed during cystoscopy ( Figure 1B, panels A-D) revealed extensive and focally suppurated necrotic remodeling of the bladder mucosa, with a few lesions of vasculitis and no granuloma. A dense mature plasma cell infiltrate, associated with numerous eosinophils, was also noted in the fragments of viable bladder mucosa. ...

Context 3

... evaluation performed 3 months later showed mild improvement of clinical symptoms and decreased CRP (60 mg/L) and IgG4 levels (3.3 g/L). CT pictures showed partial regression of the prostatic lesion but persistence of circumferential bladder thickening and increased perirectal infiltration ( Figure 1A, panel C). A novel bladder biopsy was performed, revealing schistosome eggs in the bladder wall, some of which were viable ( Figure 1B, panels E and F). ...

Context 4

... pictures showed partial regression of the prostatic lesion but persistence of circumferential bladder thickening and increased perirectal infiltration ( Figure 1A, panel C). A novel bladder biopsy was performed, revealing schistosome eggs in the bladder wall, some of which were viable ( Figure 1B, panels E and F). Corticosteroids were stopped, and the final diagnosis of urogenital schistosomiasis was retained. ...

Context 5

... were stopped, and the final diagnosis of urogenital schistosomiasis was retained. The patient received praziquantel 40 mg as a single dose repeated 14 days later, enabling progressive improvement of all symptoms, with a maximal response observed after 6 weeks of praziquantel treatment ( Figure 1A, panel E; Supplementary Table 1). Praziquantel is highly effective against adult worms, which might explain the delayed efficacy noted in this case, where only eggs were detected at the time of Schistosoma diagnosis. ...

Context 6

... is highly effective against adult worms, which might explain the delayed efficacy noted in this case, where only eggs were detected at the time of Schistosoma diagnosis. No aspect of porcelain bladder was seen on plain radiography ( Figure 1A, panel F). ...