A 'Fluke' Diagnosis: Suspecting Fascioliasis as a Rare Cause of Hepatic Abscess

Abstract

Hepatic abscess is a rare complication of fascioliasis, with fewer than 50 reported cases worldwide. The diagnosis requires a high degree of suspicion and is often identified after extensive investigation leading to delays in treatment. With this case report, we aim to highlight the need for a higher index of suspicion in non endemic regions like the USA, especially in cities with large immigrant populations. Given the ease and success rates of treatment with oral triclabendazole, the morbidity from unnecessary invasive testing and disease burden is preventable with a thorough evaluation and targeted clinical assessment.

Keywords: Cercariae; Endemic; Eosinophilia; Fascioliasis; Hepatic abscess; Liver fluke; Meta-cercariae; Trematode; Triclabendazole; Zoonotic disease.

Fig. 1

Life cycle of Fasciola hepatica. (Image from Wikimedia Commons. Author - Peter Andrus, 24th April, 2023).

Fig. 2

CT scan of the abdomen demonstrating a bilateral complex fluid collection within the inferior right hepatic lobe suggestive of a hepatic abscess.

Fig. 3

MRI of the abdomen with contrast enhancement demonstrating a 3.0 cm * 1.7 cm bilobed complex cystic lesion in segment 6 of the liver suggestive of a hepatic abscess.

Fig. 4

Hepatic abscess pathology demonstrating a liver fluke segment within the hepatic parenchyma with eosinophilic infiltration.