Acute schistosomiasis (Katayama syndrome) presents with which constellation?

• A. Fever, headache, malaise, myalgia, rash, and abdominal pain
• B. Chronic diarrhea and portal hypertension
• C. Pruritic rash at entry site only
• D. Cough and wheeze only

Answer: (A)

Acute schistosomiasis, or Katayama fever, is a systemic hypersensitivity reaction to migrating schistosome larvae that occurs weeks after exposure. The immune response drives a constellation of symptoms across multiple organs: fever, malaise, headaches, and myalgias, often with a pruritic rash. Abdominal pain comes from involvement of the liver and intestines, and eosinophilia is common. This combination—fever, headache, malaise, myalgia, rash, and abdominal pain—best reflects the acute Katayama presentation. Chronic schistosomiasis, by contrast, shows diarrhea with portal hypertension later on; cercarial dermatitis would be a localized rash at the entry site; and cough with wheeze alone doesn’t capture the full acute syndrome.