Schistosoma mansoni is most characteristically associated with which finding?

• A. Portal hypertension
• B. Bladder carcinoma
• C. Hematuria
• D. Eosinophilia

Answer: (A)

The key concept is how where the Schistosoma eggs lodge in the body determines the organ-specific disease. For Schistosoma mansoni, eggs embed in the venules of the large intestine and migrate to the liver, where they provoke a granulomatous inflammatory response around the portal tracts. This leads to progressive periportal fibrosis, known as Symmers’ fibrosis, which narrows the portal venous system and causes presinusoidal portal hypertension. Clinically this presents with signs of portal hypertension such as splenomegaly and potential variceal bleeding, rather than bladder symptoms.

Hematuria points to Schistosoma haematobium, which affects the urinary tract and causes blood in the urine and an increased risk of bladder cancer, not mansoni. Eosinophilia can occur with parasitic infections but isn’t the defining feature for mansoni. So the most characteristic finding with Schistosoma mansoni is portal hypertension due to periportal fibrosis.