A diagnostic fluke

Abstract

Fascioliasis is a foodborne trematode infection caused by the liver fluke Fasciola hepatica or Fasciola gigantica. In Australia, human cases are seen rarely and infection is often acquired overseas. This study reports the case of an 18-year-old woman from Bangladesh, with a mulitloculated liver abscess suspected secondary to F. hepatica. She presented with fever and right upper quadrant pain, and initial blood examination at our facility revealed an eosinophilia of 1.22×109/L (9%) and a mild elevation of liver function tests. An ultrasound guided drainage was sent only for cytology which revealed no malignancy. Empiric cover was given for bacterial liver abscess and blood cultures were negative. Multiple stool microscopic examinations visualised no ova, cysts or parasites. Serology demonstrated reactivity for Fasciola hepatica IgG enzyme immunoassay (EIA) and Schistosomiasis IgG EIA which was treated with praziquantel. There was non-reactive serology for Entamoeba histolytica, Echinococcus granulosus and Strongyloides. Despite treatment with triclabendazole, her case was later complicated by acute bleeding through the ampulla of vater secondary to a hepatic artery pseudoaneurysm and she received re-treatment with triclabendazole. Although we cannot differentiate between other liver flukes as the cause of her presentation, this case highlights important microbiological diagnostic considerations and treatment challenges.