A case of liver schistosomiasis japonica in which abdominal ultrasound examination was the only useful diagnostic tool

A case of liver schistosomiasis japonica in which abdominal ultrasound examination was the only useful diagnostic tool | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report A case of liver schistosomiasis japonica in which abdominal ultrasound examination was the only useful diagnostic tool Yoshiki Makino, Tetuya Kaneko This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7898080/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The case involves a 57-year-old Filipino woman living in Japan. Since 2020, she has been referred to a clinic for abnormal liver function and visited our hospital in May 2024 for further investigation. She had no specific symptoms, and a blood test at her first visit indicated mild liver dysfunction (AST 53 U/L, ALT 53 U/L, γGTP 106 U/L, ALP 138 U/L) and mild renal dysfunction (Cre 0.87 mg/dl, eGFR 52). She was negative for HBs antigen and HCV antibody. An abdominal ultrasound was performed, revealing marked atrophy of the right lobe of the liver, with a net-like structure due to linear high echogenicity across the entire right lobe (so-called 'network pattern') (Fig. 1a, Fig. 1b). There were no significant findings in the left lobe of the liver, and splenomegaly was not observed. Suspecting liver schistosomiasis japonica, a stool examination for eggs was conducted but yielded no detectable results. Dynamic CT, EOB-MRI, and contrast-enhanced ultrasound were performed, but no mass lesions were found in any of the tests. CT and MRI showed atrophy and deformation of the right lobe, but no findings suggestive of liver schistosomiasis japonica, such as the net-like linear high echogenicity observed on ultrasound, were seen(Fig. 1e,Fig. 1f). For definitive diagnosis, a liver biopsy was performed, and the pathological tissue showed eggs of schistosoma japonicum (Fig. 1c) and expansion of the fibrous portal area (Fig. 1d), leading to a diagnosis of liver schistosomiasis japonica. Figures Figure 1 Full Text The case involves a 57-year-old Filipino woman living in Japan. Since 2020, she has been referred to a clinic for abnormal liver function and visited our hospital in May 2024 for further investigation. She had no specific symptoms, and a blood test at her first visit indicated mild liver dysfunction (AST 53 U/L, ALT 53 U/L, γGTP 106 U/L, ALP 138 U/L) and mild renal dysfunction (Cre 0.87 mg/dl, eGFR 52). She was negative for HBs antigen and HCV antibody. An abdominal ultrasound was performed, revealing marked atrophy of the right lobe of the liver, with a net-like structure due to linear high echogenicity across the entire right lobe (so-called 'network pattern') (Fig.1a, Fig.1b). There were no significant findings in the left lobe of the liver, and splenomegaly was not observed. Suspecting liver schistosomiasis japonica, a stool examination for eggs was conducted but yielded no detectable results. Dynamic CT, EOB-MRI, and contrast-enhanced ultrasound were performed, but no mass lesions were found in any of the tests. CT and MRI showed atrophy and deformation of the right lobe, but no findings suggestive of liver schistosomiasis japonica, such as the net-like linear high echogenicity observed on ultrasound, were seen(Fig.1e,Fig.1f). For definitive diagnosis, a liver biopsy was performed, and the pathological tissue showed eggs of schistosoma japonicum (Fig.1c) and expansion of the fibrous portal area (Fig.1d), leading to a diagnosis of liver schistosomiasis japonica. In the literature, the findings reflecting the fibrosis and calcification of the intrahepatic portal vein region appear as linear high echogenicity in ultrasound examinations, exhibiting a net-like structure referred to as a 'network pattern' or 'fish scale pattern'. Similar findings can also be observed in CT, known as the 'turtle back pattern'. On MRI, they are reported to be detected as low signal on T1-weighted images and high signal on T2-weighted images[1]. However, in this case, findings were only observed on abdominal ultrasonography. The factors considered include differences in the detection capabilities for fibrosis and calcification due to the fundamental differences in each examination, as well as differences in the resolution of each test, but a liver biopsy examines only a portion of the liver and therefore cannot lead to a definitive conclusion. Declarations Finantial interests The authors did not receive support from any organization for the submitted work. Ethical approva l and accordance The protocol was approved by kouseikai hospital ethical committee in accordance with the kouseikai hospital ethical committee relevant guidelines and regulations. Consent to participate Informed consent was obtained from the patient for participation in this study. Consent to publish Informed consent was obtained from the patient for publication of the images. References Manzella A, Kuni Ohtomo. Shistosomiasis of the liver. Abdominal imaging (Abdominal radiology). Springer. 2008;33:144–50. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7898080","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":536898875,"identity":"5110f695-20a5-481d-a17a-f4f69b06d9d0","order_by":0,"name":"Yoshiki Makino","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4ElEQVRIiWNgGAWjYFACNoYDDAw1cmzMzECaQUKGWC3HjPnZ2RJAWniI0gIEzImS/TwGIBZhLbrtxxIPF1SwJRgc5vn86kaNBQ8D++GjG/BpMTuTduDwjDMyeQaHebdZ5xwDOownLe0GXi0H0hsO87axFYO0GOewAbVI8Jjh13L+OUgLc+KGwzzPjHP+EaPlBtBhIC0zm3mYH+e2EaXlWcJhnjPAQGZmM2PO7ZPgYSPol/Npxp95KoBRyX/48eecb3Vy/OyHj+HVggzYJMAkscpBgPkDKapHwSgYBaNg5AAAtjJHoGs8j70AAAAASUVORK5CYII=","orcid":"","institution":"kouseikai hospital","correspondingAuthor":true,"prefix":"","firstName":"Yoshiki","middleName":"","lastName":"Makino","suffix":""},{"id":536898876,"identity":"4d4047a0-f0ea-43eb-b179-08994dbc44a4","order_by":1,"name":"Tetuya Kaneko","email":"","orcid":"","institution":"kouseikai hospital","correspondingAuthor":false,"prefix":"","firstName":"Tetuya","middleName":"","lastName":"Kaneko","suffix":""}],"badges":[],"createdAt":"2025-10-19 11:08:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7898080/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7898080/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":95670225,"identity":"2fa4c21e-910f-423f-9f5a-cf710ba8b70e","added_by":"auto","created_at":"2025-11-11 17:17:37","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":18855,"visible":true,"origin":"","legend":"","description":"","filename":"Acaseofliverschistosomiasisjaponica.docx","url":"https://assets-eu.researchsquare.com/files/rs-7898080/v1/c93f810e7e1847d01e6e7143.docx"},{"id":95670228,"identity":"daef250d-4d66-4baf-bb32-981d45138c70","added_by":"auto","created_at":"2025-11-11 17:17:37","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":2734,"visible":true,"origin":"","legend":"","description":"","filename":"aa222abf1b7b43db8143430b882d7c93.json","url":"https://assets-eu.researchsquare.com/files/rs-7898080/v1/6f94f93458491175a3d6806b.json"},{"id":95670229,"identity":"ad0b61a7-53a3-4902-bfa8-985452382cd8","added_by":"auto","created_at":"2025-11-11 17:17:37","extension":"jpg","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":173306,"visible":true,"origin":"","legend":"","description":"","filename":"image51.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7898080/v1/585b3cfb2f631201e9b84684.jpg"},{"id":95670231,"identity":"f56a1f5c-712c-48e5-8c6f-6e28a8431353","added_by":"auto","created_at":"2025-11-11 17:17:38","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":11070,"visible":true,"origin":"","legend":"","description":"","filename":"aa222abf1b7b43db8143430b882d7c931enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7898080/v1/3bc3efd545bf03e5ffa71adc.xml"},{"id":95797811,"identity":"cbfc5cd7-d923-493d-a7c2-bf43a221db86","added_by":"auto","created_at":"2025-11-13 08:11:22","extension":"xml","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":9594,"visible":true,"origin":"","legend":"","description":"","filename":"aa222abf1b7b43db8143430b882d7c931structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7898080/v1/f5855cb1dff65300139cd850.xml"},{"id":95670226,"identity":"5bdc9e02-a238-4954-85c2-38435e20864d","added_by":"auto","created_at":"2025-11-11 17:17:37","extension":"html","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":14326,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7898080/v1/fdc42a74dfef8b3559334ad0.html"},{"id":95670230,"identity":"71eb0d4e-2b19-4fb1-b252-2842d8b7c7d3","added_by":"auto","created_at":"2025-11-11 17:17:37","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":173306,"visible":true,"origin":"","legend":"\u003cp\u003eFig.1 \u003cstrong\u003ea\u003c/strong\u003e,\u003cstrong\u003eb\u003c/strong\u003e Abdominal ultrasound rt subcostal view showing net-like linear high echogenicity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ec \u003c/strong\u003eLiver biopsy pathological image HE staining, showing eggs of Japanese schistosomiasis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ed\u003c/strong\u003e Liver biopsy pathological image HE staining, showing eggs of Japanese schistosomiasis and fibrous enlargement of the portal vein region (↑).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ee\u003c/strong\u003e abdominal CT ,showing atrophiy of the right lobe, 'turtle back pattern' was not detected\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ef\u003c/strong\u003e MRI (T1WI) ,showing atrophiy of the right lobe, linear low signal was not detected\u003c/p\u003e","description":"","filename":"image51.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7898080/v1/d0c5e62f6232b80cf148c70a.jpg"},{"id":96801557,"identity":"22d26415-cc18-4d2b-80b6-7bb5119ea9ce","added_by":"auto","created_at":"2025-11-26 08:39:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":408303,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7898080/v1/958884c2-af0d-4b9c-afd6-6f81f3dd18ad.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A case of liver schistosomiasis japonica in which abdominal ultrasound examination was the only useful diagnostic tool","fulltext":[{"header":"Full Text","content":"\u003cp\u003eThe case involves a 57-year-old Filipino woman living in Japan. Since 2020, she has been referred to a clinic for abnormal liver function and visited our hospital in May 2024 for further investigation. She had no specific symptoms, and a blood test at her first visit indicated mild liver dysfunction (AST 53 U/L, ALT 53 U/L, \u0026gamma;GTP 106 U/L, ALP 138 U/L) and mild renal dysfunction (Cre 0.87 mg/dl, eGFR 52). She was negative for HBs antigen and HCV antibody. An abdominal ultrasound was performed, revealing marked atrophy of the right lobe of the liver, with a net-like structure due to linear high echogenicity across the entire right lobe (so-called \u0026apos;network pattern\u0026apos;) (Fig.1a, Fig.1b). There were no significant findings in the left lobe of the liver, and splenomegaly was not observed. Suspecting liver schistosomiasis japonica, a stool examination for eggs was conducted but yielded no detectable results. Dynamic CT, EOB-MRI, and contrast-enhanced ultrasound were performed, but no mass lesions were found in any of the tests. CT and MRI showed atrophy and deformation of the right lobe, but no findings suggestive of liver schistosomiasis japonica, such as the net-like linear high echogenicity observed on ultrasound, were seen(Fig.1e,Fig.1f). For definitive diagnosis, a liver biopsy was performed, and the pathological tissue showed eggs of schistosoma japonicum (Fig.1c) and expansion of the fibrous portal area (Fig.1d), leading to a diagnosis of liver schistosomiasis japonica.\u003c/p\u003e\n\u003cp\u003eIn the literature, the findings reflecting the fibrosis and calcification of the intrahepatic portal vein region appear as linear high echogenicity in ultrasound examinations, exhibiting a net-like structure referred to as a \u0026apos;network pattern\u0026apos; or \u0026apos;fish scale pattern\u0026apos;. Similar findings can also be observed in CT, known as the \u0026apos;turtle back pattern\u0026apos;. On MRI, they are reported to be detected as low signal on T1-weighted images and high signal on T2-weighted images[1].\u003c/p\u003e\n\u003cp\u003eHowever, in this case, findings were only observed on abdominal ultrasonography. The factors considered include differences in the detection capabilities for fibrosis and calcification due to the fundamental differences in each examination, as well as differences in the resolution of each test, but a liver biopsy examines only a portion of the liver and therefore cannot lead to a definitive conclusion.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFinantial interests\u003c/strong\u003e \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors did not receive support from any organization for the submitted work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approva\u003c/strong\u003el \u003cstrong\u003eand accordance\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe protocol was approved by kouseikai hospital ethical committee in accordance with the kouseikai hospital ethical committee relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from the patient for participation in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from the patient for publication of the images.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eManzella A, Kuni Ohtomo. Shistosomiasis of the liver. Abdominal imaging (Abdominal radiology). Springer. 2008;33:144\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7898080/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7898080/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe case involves a 57-year-old Filipino woman living in Japan. Since 2020, she has been referred to a clinic for abnormal liver function and visited our hospital in May 2024 for further investigation. She had no specific symptoms, and a blood test at her first visit indicated mild liver dysfunction (AST 53 U/L, ALT 53 U/L, γGTP 106 U/L, ALP 138 U/L) and mild renal dysfunction (Cre 0.87 mg/dl, eGFR 52). She was negative for HBs antigen and HCV antibody. An abdominal ultrasound was performed, revealing marked atrophy of the right lobe of the liver, with a net-like structure due to linear high echogenicity across the entire right lobe (so-called 'network pattern') (Fig.\u0026nbsp;1a, Fig.\u0026nbsp;1b). There were no significant findings in the left lobe of the liver, and splenomegaly was not observed. Suspecting liver schistosomiasis japonica, a stool examination for eggs was conducted but yielded no detectable results. Dynamic CT, EOB-MRI, and contrast-enhanced ultrasound were performed, but no mass lesions were found in any of the tests. CT and MRI showed atrophy and deformation of the right lobe, but no findings suggestive of liver schistosomiasis japonica, such as the net-like linear high echogenicity observed on ultrasound, were seen(Fig.\u0026nbsp;1e,Fig.\u0026nbsp;1f). For definitive diagnosis, a liver biopsy was performed, and the pathological tissue showed eggs of schistosoma japonicum (Fig.\u0026nbsp;1c) and expansion of the fibrous portal area (Fig.\u0026nbsp;1d), leading to a diagnosis of liver schistosomiasis japonica.\u003c/p\u003e","manuscriptTitle":"A case of liver schistosomiasis japonica in which abdominal ultrasound examination was the only useful diagnostic tool","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-11 17:17:32","doi":"10.21203/rs.3.rs-7898080/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"caa355dc-1483-4f87-b382-a7d64dfbdaa6","owner":[],"postedDate":"November 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-26T08:39:09+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-11 17:17:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7898080","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7898080","identity":"rs-7898080","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}