Cutaneous ectopic schistosomiasis associated with Löffler syndrome. A rare case report

Schistosomiasis mansoni is an endemic disease in Brazil, usually causing systemic symptoms, mainly gastrointestinal. Skin lesions are best described in the acute phase of the infection, with ectopic skin lesions rarely seen. We report a case of schistosomiasis with rare ectopic cutaneous involvement, with perianal papules and plaques, acquired in the state of São Paulo in 2020. At the beginning of the investigation, the hypothesis of infection by COVID-19 was raised, due to a pulmonary condition, but it was discarded after a negative PCR for the virus. Due to eosinophilia, pulmonary CT characteristics and epidemiology, Löffler’s syndrome was suspected. The definitive diagnosis of schistosomiasis was given, after the onset of the skin rash, by the anatomopathological examination of the skin biopsy, thus avoiding an invasive examination—lung biopsy, in the patient who was using anticoagulants. The protoparasitological examination of faeces was negative. The patient was treated with Praziquantel, with the improvement of the condition. This report demonstrates the importance of dermatological examination and skin biopsy for the definitive diagnosis of Schistosomiasis in a patient with severe systemic manifestations.