Hepatic fascioliasis of emphasizing diagnostic difficulty and the need for high index of suspicion: Four case reports

Fasciola hepatica (F. hepatica) (liver fluke) is a parasitic trematode that infects humans through the consumption of contaminated aquatic plants harboring the infective stage of the parasite. Despite being a neglected tropical disease, a World Health Organization report estimates that it affects approximately 2.4 million people worldwide, with high endemicity in regions characterized by poor sanitation and limited access to clean water. Clinical manifestations range from asymptomatic infection to severe complications such as liver abscess and multi-organ involvement.

We report 4 cases with varied and unusual presentations. Case 1: A 41-year-old woman with an initial presumptive clinical diagnosis of liver malignancy. Case 2: A 34-year-old woman who presented with urticaria and eosinophilia, initially suspected to be vasculitis. Case 3: A 67-year-old man who presented with dyspeptic symptoms, easy fatigability, headache, and fever. Case 4: A 60-year-old patient who presented with an eosinophilic liver abscess after prolonged antibiotic treatment failure.

Hepatic fascioliasis is frequently misdiagnosed due to its non-specific symptoms and limited diagnostic tools, especially in resource-limited settings. It is crucial to enhance awareness among healthcare professionals regarding its recognition and appropriate management. This case report aims to contribute to the growing body of literature on F. hepatica infection to facilitate timely diagnosis and empiric treatment with triclabendazole or nitazoxanide, as these are effective and reduce unnecessary interventions.