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Hepatosplenic Schistosomiasis — RACP Adult Medicine MCQ

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ModerateInfectious DiseasesHepatosplenic SchistosomiasisRACP Adult Medicine

A 55-year-old man with known schistosomiasis (S. mansoni) acquired in Egypt 20 years ago presents with haematemesis from oesophageal varices. His liver biopsy shows periportal (Symmers pipestem) fibrosis with preserved hepatocellular function. What is the pathological hallmark?

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Correct answer: D — Pre-sinusoidal portal hypertension with preserved hepatic function

Hepatosplenic schistosomiasis causes characteristic periportal (Symmers pipestem) fibrosis from granulomatous reaction around deposited eggs in portal venules. This causes pre-sinusoidal portal hypertension (variceal bleeding, splenomegaly, hypersplenism) while hepatocellular function is typically preserved (unlike cirrhosis). The distinction from cirrhosis is important clinically. Treatment is praziquantel 40 mg/kg as a single dose (for S. mansoni). Variceal bleeding is managed as per standard guidelines.

Reference: eTG – 2025 – Antibiotic Guidelines; WHO – 2022 – Schistosomiasis Guidelines