Afro-Egypt J Infect  Endem  Dis  2018 December ; 8(4):218

 

Hepatic Fascioliasis, Unexpected Diagnosis and Atypical Presentation

Tarik Zaher¹, Elsayed Saad¹, Ahmad Elsamak²

¹Tropical Medicine Department, Faculty of Medicine, Zagazig University, Egypt

²Radiology Department, Faculty of Medicine, Zagazig University, Egypt

dr.sayedsaad79@ gmail.com

 

ABSTRACT

A 35 years old female living in a village belongs to Zagazig, a city in the Nile delta, Egypt, presented to another health institute with upper abdominal pain, anorexia for one month. Her blood results were as follow; normal complete blood count (CBC), increased alanine aminotransferase (ALT) and aspartate aminotransferase (AST) more than twice the upper limit of normal, alkaline phosphatase (ALP): 185 U/L, gamma-glutamyl transpeptidase (GGT): 115 U/L and bilirubin: 1.5 mg/dl. Abdominal ultrasonography showed hypo-echoic focal lesions with ill-defined borders which were confirmed by abdominal CT. Her physician gave a probable diagnosis of HCC (based on high incidence of HCC in our community) and referred to our hospital. On admission the patient complained of upper abdominal pain. On examination there was no fever, no jaundice, and no organomegaly. Repeated laboratory tests showed normal CBC, ALT; 55 U/L, AST; 43U/L, ALP; 143 U/L, GGT; 96  U/L,  bilirubin;  2 mg/dl  and Alfa fetoprotein (AFP); 6 ng/ml. Abdominal CT imaging confirmed the presence of multiple branching hypo-dense focal lesions in segments 7 and 8 of the liver but no cirrhosis (Fig. 1). Serology for viral hepatitis (B,C) was negative. However, repeated stool analysis revealed Fasciola eggs. Nitazoxanide was given for one month. Her symptoms resolved and liver biochemistry improved. However, CT abdomen showed regression of the lesions but didn’t disappear completely, so, Triclabendazole 10mg/kg was given once. Two months later, there was resolution of the focal lesions completely.