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The sonographic characteristics of the gallbladder content excluded the diagnosis of a neoplastic process, suggesting instead a parasitic infestation. Microscopy of fresh stool sample revealed non-embryonated eggs of Fasciola hepatica. Such a trematode usually parasitises herbivorous mammals. Humans are accidentally infected by the ingestion of water or raw vegetables contaminated with the metacercaria. Human fascioliasis occurs in two steps: an acute phase, coinciding with hepatic invasion; and a chronic phase, caused by persistence of the adult form in the biliary tract, where it releases eggs. This latter situation occurred in our patient, presenting recurrent episodes of cholangitis. Anamnesis and specific ultrasound findings1 led to the correct diagnosis. The patient received triclabendazole in two oral postprandial doses of 100 mg, 12 h apart, which resulted in eradication of the parasite.
- Richter J, Freise S, Mull R, et al. Fascioliasis: sonographic abnormalities of the biliary tract and evolution after treatment with triclabendazole. Trop Med Int Health 1999; 4: 774–81.[CrossRef][Medline]
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