Fasciola hepatica als Ursache einer Leberwerterhöhung mit Eosinophilie - serologische und endoskopische Diagnostik und Therapie

Abstract

A 36 year old man was diagnosed with eosinophilia and elevated liver-enzyme levels in a preoperative routine laboratory testing. In the course of the evaluation we found high levels of Fasciola hepatica specific antibodies which lead to an ERC with biliary aspiration after choleretic stimulation. The bile showed Fasciola eggs and subsequently we recovered a parasite from the bile duct. Abdominal CT- and MRI-Scans showed lesions of the liver consistent with hepatic fascioliasis. Focussed patient's history revealed ingestion of contaminated watercress in Turkey as the most likely source of infection. For patients with elevated liver-enzymes of unknown etiology with eosinophilia or in combination with a congruent patient's history even without eosinophilia serologic studies of Fasciola hepatica seem to be advisable. We suggest an ERC with biliary aspiration to prove the diagnosis in case of positive results, if the prepatency period of 4 months after the ingestion is over. Fasciola hepatica is rarely diagnosed in Germany probably due to the lack of awareness of the disease.

Multiple liver masses in a patient with breast cancer, metastasis or not? An unexpected diagnosis: hepatic fascioliasis. A case report and overview of the literature from Turkey

“…There are many published reports of human FH infections coming from these regions ( Table 2 ), and also there are some case reports related to European travellers. 30 – 33 F. gigantica does not have the ability to spread like F. hepatica , but can be seen infrequently in Turkey. 4 There are only two case reports of biliary F. gigantica , which is distinguished from F. hepatica with its morphological features.…”

Review of Dancing Parasites in Lymphatic Filariasis

“…Parasitic diseases are rarely encountered in Europe and the clinical and imaging features are generally not well known. In the era of worldwide migration and refugees, knowledge of such diseases has gained importance as illustrated by multiple recently published reports of hydatid diseases 1 2 3 4 5 , schistosomiasis 6 7 , fasciolosis 8 , ascariasis 9 , liver flukes 10 , toxocariasis and other rare intestinal diseases 11 12 . This article describes the clinical and imaging features along with current treatment strategies for filariasis.…”