Schistosoma -associated colorectal carcinoma in a young male

Colorectal carcinoma typically affects older adults, but SA-CRC has been reported at a younger age, with studies showing onset 6–16 years earlier than sporadic CRC in endemic areas.1 Chronic infection with Schistosoma species is classified by the International Agency for Research on Cancer as a possible human carcinogen (Group 2B).2 Schistosoma japonicum and Schistosoma haematobium have been implicated as a causative agent for hepatocellular carcinoma and urinary bladder carcinoma, respectively, although definitive evidence for colorectal cancer is lacking. SA-CRC is characterized by a higher prevalence of mucinous histology and distal colon or rectal involvement.3 Here we report a case of SA-CRC in a young male. A man in his 20s, a college student living in Delhi, India, for 1 year and originally from rural Bangladesh, with no comorbidities or addictions, presented with bleeding per rectum and a prolapsing rectal mass for 1.5 years, along with new-onset progressive constipation over 4 months. He denied weight loss, anorexia, abdominal pain or other systemic symptoms. He had a history of intermittently symptomatic internal haemorrhoids since childhood, with no significant family history suggestive of malignancy, tuberculosis or chronic illness. He was clinically stable; baseline labs were normal, with no eosinophilia. HIV and hepatitis B and C were negative.