A previously fit 8-year-old boy with recurrent end-stage botrythematuria for two weeks. Two years ago, the child developed painless end-stage hematuria after swimming near a dam in Ghana, which resolved with treatment. Urine microscopy showed more than 250/mm3 red blood cells (normal is 0-5). Urine sediment revealed ovoid eggs (approximately 110-170 μm long and 50-70 μm wide) with terminal spines and clear oocysts, typical of Schistosoma egypti. Trichuris and larvae usually living in the natural environment water (lakes, rivers) were also found. Schistosoma egypti is endemic in freshwater bodies of sub-Saharan Africa, where infection occurs after swimming in these bodies of water. The adult worms parasitizing the bladder and pelvic plexus release eggs. The eggs penetrate the bladder wall and oviducts and form granulomas and fibroids, which cause hematuria and chronic inflammation. If left untreated, this can lead to ureteral obstruction, secondary urinary tract infections, and even the development of squamous bladder cancer and eventual kidney failure. This child was treated with praziquantel and after eight weeks of follow-up, the hematuria disappeared and the eggs and caterpillars were completely cleared.