In a case presenting with abdominal pain, hepatosplenomegaly, and hematuria after swimming in the Nile, what is the likely diagnosis?

The clinical presentation of abdominal pain, hepatosplenomegaly, and hematuria, particularly after swimming in the Nile, strongly suggests schistosomiasis. This parasitic infection is caused by Trematodes (fluke worms) from the genus Schistosoma, which are often found in freshwater bodies, such as the Nile River.

Hematouria is particularly indicative of schistosomiasis caused by Schistosoma haematobium, which predominantly affects the urinary tract and can lead to symptoms such as blood in the urine, abdominal pain, and enlargement of the liver and spleen. Exposure to contaminated water, where the snail intermediate hosts dwell, raises the risk for this infection.

In contrast, while hepatitis might cause jaundice and liver dysfunction, it typically does not present with hematuria or significant splenomegaly. Malaria can cause abdominal pain and splenomegaly, but hematuria is less common and is more associated with severe cases. Leptospirosis can present with similar systemic symptoms but is not linked to hematuria as prominently as schistosomiasis.

Thus, the combination of symptoms and exposure history leads to the conclusion that schistosomiasis is the most likely diagnosis in