Platyhelminthic Cholangiopathy: A Case Report of Biliary Fascioliasis

Human fascioliasis, a zoonotic infection caused by the platyhelminths Fasciola hepatica and F. gigantica, is a neglected tropical disease geographically limited to regions in South America, Africa, and Middle and South East Asia. It primarily infects mammals, particularly cattle, which serve as definitive hosts, while freshwater snails act as intermediate hosts. Human infection occurs through ingesting metacercariae found in contaminated water or aquatic plants. The disease presents with right upper abdominal pain, fever, and, at times, jaundice, hepatomegaly, and biliary obstruction. Diagnosis can be challenging due to its rarity; stool microscopy and serology often aid in diagnosis. Cross-sectional imaging and endoscopic retrograde cholangiopancreatography (ERCP) may identify the mobile helminths; the latter remains the gold standard for diagnosis. The drug of choice for fascioliasis is triclabendazole, the only drug with proven efficacy in human fascioliasis, though its availability may be limited in non-endemic regions. This case report discusses a 25-year-old male who presented with fever and right upper quadrant abdominal pain, with peripheral eosinophilia and elevated alkaline phosphatase levels. Abdominal imaging suggested biliary dilatation and sludge, while ERCP, unexpectedly multiple platyhelminths were retrieved from the biliary tree, subsequently identified as F. hepatica. The patient was successfully treated with two doses of oral triclabendazole, and he remained symptom-free during a six-month follow-up. This rare case highlights the diagnostic and treatment challenges of human fascioliasis outside endemic regions, offering insights into the unexpected presentation of liver flukes.