Abstract
Schistosomiasis (Bilharziasis) is a disease caused by parasitic worms that live in certain freshwater snails and affect people in developing countries. Chronic Schistosomiasis with perianal fistula is an unusual presentation. We report the case of a 31-year-old Sudanese male who suffered from chronic anal discharge and was found to have a perianal fistula. He began empirically taking oral mesalamine three times daily, then underwent a colonoscopy to rule out Crohn's disease and discovered Schistosoma eggs in a tissue biopsy. This case suggests that Schistosomiasis infection should be considered one of the causes of perianal fistula or abscess if the patient had traveled to endemic areas of Schistosomiasis in the past.