Hepatic parasitic abscess resistant to traditional anthelmintics: difficulty of diagnosis and treatment of fascioliasis in the USA

We report a case of human fascioliasis in the USA that encountered many diagnostic uncertainties. Numerous tests available for detection of fascioliasis were utilised but the diagnosis remained elusive. Confounders included three negative stool ova and parasite examinations, positive hepatitis A vir...

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Bibliographic Details
Published in:BMJ case reports 2021-07, Vol.14 (7), p.e242613
Main Authors: Lee, Roland Y, White, Rachel V, Shin, Benjamin J, Collins, Belinda G
Format: Article
Language:English
Subjects:
Abdomen
Animals
Anthelmintics - therapeutic use
Antibodies
Antigens
Benzimidazoles - therapeutic use
Biopsy
Blood
Case Report
Case reports
Disease control
Eggs
Fascioliasis - diagnosis
Fascioliasis - drug therapy
Hepatitis B
Humans
Infections
Infectious diseases
Liver
Liver diseases
Medical diagnosis
Medical laboratories
Pain
Parasites
Parasitic diseases
Triclabendazole - therapeutic use
Ultrasonic imaging
United States
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Summary:We report a case of human fascioliasis in the USA that encountered many diagnostic uncertainties. Numerous tests available for detection of fascioliasis were utilised but the diagnosis remained elusive. Confounders included three negative stool ova and parasite examinations, positive hepatitis A virus IgM antibody, cross-reactive false-positive Echinococcus IgG antibody, absence of characteristic image findings and unrevealing liver biopsy. Praziquantel was started as empiric treatment for helminth infections, but was ineffective. Due to the rarity of the disease in the USA, serologic testing and triclabendazole were only available from the Centers for Disease Control and Prevention, which led to a delay in diagnosis and treatment.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2021-242613