Subretinal granuloma, retinal vasculitis and keratouveitis with secondary subretinal glaucoma by schistosomiasis

Background. More than 250 million people in Africa and Asia currently suffe r from schistosomiasis, however, ocular manifestations of this disease are rare in Germany. Patient and follow-up. We present the case of a 32-year-old patient from Ga mbia who had been resident in Germany for 3 years and suffered from a painf ul persistent diarrhoea,fever and a reduction of visual acuity (R>L). On ad mission,the patient reported a schistosomiasis in 1994, which was diagnosed by a skin test and was not adequately treated because of the side-effects of praziquantel. Vision was OD -0.75sph 0.8, OS sc 1.0, IOD OD 31, OS 18 mm Hg. Biomicroscopy: R>L fatty retrocorneal precipitates, especially in the l ower circumference (ARLT), large inflammatory cells and Tyndall ++, vitreou s with large inflammatory cells, Fundus: OD at 11 o'clock large subretinal granuloma in the periphery. Serum lysozyme was elevated (22.2 mg/l, normal range 10-17 mg/l),a syphilis stage II-III (TPHA 1:5000,VDRL neg.) and an Ig G-antibody titre for Schistosoma mansoni of >30 mug/ml was detected by enzy me immunoassay. In the faeces and urine no schistosoma eggs were found. Bef ore the specific treatment for schistosomiasis could be initiated,the patie nt left the hospital because of reduced ocular pain due to the corticostero ids and fear of the side-effects of the treatment. Discussion. Inpatients who present a subretinal granuloma and report a pain ful persistent diarrhoea, schistosomiasis, which is one of the most frequen t tropical diseases should be considered, even if they have been living in central Europe for several years. Although the disease cannot become establ ished due to the lack of specific hosts in this area, a curative treatment should be enforced in order to prevent late manifestations of chronic infla mmatory organ manifestations.