Fluctuating jaundice and intestinal bleeding in a 6-year-old girl with fascioliasis

A six-year-old girl presented with fever, haematemesis, melaena, fluctuating jaundice, tender hepatomegaly, palpable gall bladder and eosinophilia. At laparotomy a liver fluke was removed from the common bile duct. Despite treatment with praziquantel and metronidazole she succumbed to severe gastrointestinal bleeding.