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

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Case report
Hepatic parasitic abscess resistant to traditional anthelmintics: difficulty of diagnosis and treatment of fascioliasis in the USA
  1. Roland Y Lee1,
  2. Rachel V White1,
  3. Benjamin J Shin2 and
  4. Belinda G Collins2
  1. 1Internal Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
  2. 2Radiology, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
  1. Correspondence to Dr Belinda G Collins; bcollins{at}pennstatehealth.psu.edu

Abstract

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.

  • infection (gastroenterology)
  • liver disease

https://doi.org/10.1136/bcr-2021-242613

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    Footnotes

    • Twitter @RolandLeeMD

    • Contributors All authors (RYL, RVM, BJS, BGC) fulfil the four ICMJE criteria for authorship: (1) substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work; AND (2) drafting the work or revising it critically for important intellectual content; AND (3) final approval of the version to be published; AND (4) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.