Halzoun, an allergic pharyngitis syndrome in Lebanon: the trematode Dicrocoelium dendriticum as an additional cause

Halzoun syndrome typically manifests in the form of an allergic pharyngitis following the consumption of raw or undercooked ovine liver. First described in Lebanon in 1905, it was initially attributed to Fasciola hepatica, while later publications have attributed it to other pathogens. There has been no definitive documentation of the pathogen causing the Lebanese Halzoun syndrome. The aim of our study was to identify the parasite responsible for the pathogenesis of the Lebanese Halzoun syndrome. 32 patients with typical clinical symptoms of Halzoun syndrome were recruited in the emergency room at our hospital from 2005 to 2007. One parasite was isolated from a patient's expectorations, and two others were isolated from pieces of a raw sheep liver retrieved from the patients' dishes. A piece of infected goat liver intended for consumption was also collected from a local butcher. All parasites were examined microscopically for identification. All patients presented with immune allergic-like symptoms of the eyes, ears, nose, or throat. All collected parasites were identified as Dicrocoelium dendriticum. Our study has identified D. dendriticum, rather than Linguatula serrata or F. hepatica, as the prime suspect in the pathogenesis of the Lebanese Halzoun syndrome.