Fasciolopsis buski Diagnosed by Upper Gastrointestinal Endoscopy

A 36-year-old male patient from rural South Bengal, India, presented to our hepatology outpatient department (OPD) with upper abdominal discomfort, anorexia, indigestion, and chronic diarrhea with passage of loose stools 3-4 times per day for 6 weeks. He was afebrile without any weight loss. He did not give any history of skin changes, arthralgia, or oral ulceration. He gave a history of consumption of water chestnuts. He had no history of travel or intake of alcohol or any medications. Physical examination did not reveal any lymphadenopathy, thyroid mass, organomegaly, or abdominal mass. Blood reports showed anemia with a hemoglobin of 78 gm/L (normal range 130-170 gm/L), and total leukocyte count showed eosinophilia (12%). Liver function test showed mild hypoalbuminemia. Human immunodeficiency virus, hepatitis B virus surface antigen, and antihepatitis C virus antibody were nonreactive. Abdominal ultrasonography was normal. Initial stool examination was normal. On upper gastrointestinal (GI) endoscopy, multiple flat, leaf-like, fleshy structures attached to duodenum were found, which were extracted endoscopically (Fig. 1 and Supplementary Video S1). They were morphologically identical to adult form of Fasciolopsis buski (3.5 cm × 1.5 cm × 0.5 cm) (Figs 2 and 3). He was treated with tablet praziquantel (75 mg/kg, in three divided doses for 1 day). The next day, stool examination showed eggs of F. buski (morphologically, eggs of F. buski, Fasciola hepatica, and Fasciola gigantica are similar) (Fig. 4). A few adult worms of F. buski were also expelled through feces for 2 days. From the 3rd day onward, stool examination did not show any eggs or adult forms of F. buski, and he was asymptomatic for a 6-month follow-up period.