A case study of fascioliasis with special reference to immunoserological tests and diagnostic imagings

Abstract

We reported a case of fascioliasis diagnosed by immunological methods and various kinds of diagnostic imaging technique (ultrasonography, computed tomography and angiography). While the presence of ova or parasites was not confirmed, the diagnosis was ascertained by the improvement of clinical symptoms during the bithionol treatment.
A 28 year-old man was admitted to our hospital because of epigastric colicky pain. The examinations revealed hepatomegaly, marked eosinophilia, elevated serum IgE and hepatic dysfunction. The diagnostic imaging showed characteristic tumors in the right hepatic lobe, especially on CT. CT revealed polycystic low density areas. Laparoscopy demonstrated a white nodule on the right hepatic lobe and the biopsy specimen obtained from the nodule showed scars and portal fibrosis with marked eosinophilic infiltration. The laboratory data and diagnostic imaging suggested a parasitic disease. The examination for feces and bile juice revealed no parasite egg. However, fascioliasis was diagnosed due to prominent positive reaction for fasciola antigen by Ouchterlony double immunodiffusion test. The administration of bithionol (total 89.6g) normalized the laboratory data except for the elevated serum IgE after three months course of the treatment. The sequential study of CT scan had shown disappearance of low density areas after the treatment.