Unexpected uterine microhabitat of Schistosoma infection: a migrant case of female genital schistosomiasis in Europe.

BACKGROUND: Female genital schistosomiasis (FGS) is an underrecognized cause of infertility and may remain undiagnosed in non-endemic settings because of nonspecific symptoms and limited sensitivity of routine diagnostic tests. CASE PRESENTATION: We report the case of a 30-year-old woman from Côte d'Ivoire who had lived in Mali before migrating to Spain and then presented with primary infertility. Initial fertility workup revealed a large intramural-submucosal leiomyoma. Following myomectomy, histopathological examination unexpectedly identified Schistosoma eggs associated with granulomatous inflammation in the myometrial specimen. Initial Schistosoma serology and urine microscopy were negative. Hysterosalpingography later demonstrated right hydrosalpinx, prompting reconsideration of schistosomiasis. Repeated urine samples collected after endometrial biopsy revealed Schistosoma haematobium-like eggs, confirming the diagnosis. Retrospective review showed previous eosinophilia despite the absence of urinary symptoms or hematuria. The patient was treated with praziquantel, and follow-up samples were negative. CONCLUSIONS: This case highlights FGS as a potentially reversible cause of infertility in migrant women from endemic regions. It also underscores the diagnostic limitations of serology and urine microscopy and the importance of histopathological examination in establishing the diagnosis.