[Fascioliasis after a stay in Turkey]

Abstract

History and admission findings: A 42-year-old man who had just returned from a trip to Turkey presented with recurrent right upper abdominal pain and bouts of fever. Physical examination was unremarkable except for an enlarged liver on palpation.

Investigations: There was a slight increase in tests indicating cholestasis and in transminases. There was a marked eosinophilia of 57% in the differential blood count. Ultrasound examination indicated an inhomogeneous and enlarged right lobe of the liver with a 2.5 x 3 cm poorly circumscribed echo-poor space-occupying lesion. Computed tomography demonstrated multiple hypodense foci. Needle biopsy revealed a histological picture suggesting parasite infection.

Diagnosis, treatment and course: The patient was referred to a department of tropical medicine. His symptoms progressed and the antibody titre for Fasciola hepatica was increased, but no Fasciola eggs were found in the stool. Administration of triclabendazole resulted in lasting regression of the symptoms and a dramatic fall in eosinophilia to ultimately 6%.

Conclusion: In eosinophilia of undetermined origin parasitic infection should be considered and any previous visit to countries with endemic parasitic disease taken into account.