[Infection with fasciola hepatica causing elevated liver-enzyme results and eosinophilia - serologic and endoscopic diagnosis and therapy].
A 36 year old man was diagnosed with eosinophilia and elevated liver-enzyme levels in a preoperative routine laboratory testing. In the course of the evaluation we found high levels of Fasciola hepatica specific antibodies which lead to an ERC with biliary aspiration after choleretic stimulation. The bile showed Fasciola eggs and subsequently we recovered a parasite from the bile duct. Abdominal CT- and MRI-Scans showed lesions of the liver consistent with hepatic fascioliasis. Focussed patient's history revealed ingestion of contaminated watercress in Turkey as the most likely source of infection. For patients with elevated liver-enzymes of unknown etiology with eosinophilia or in combination with a congruent patient's history even without eosinophilia serologic studies of Fasciola hepatica seem to be advisable. We suggest an ERC with biliary aspiration to prove the diagnosis in case of positive results, if the prepatency period of 4 months after the ingestion is over. Fasciola hepatica is rarely diagnosed in Germany probably due to the lack of awareness of the disease.
Christmann
M
M
Klinik Innere Medizin II, Dr.-Horst-Schmidt-Kliniken GmbH, Ludwig-Erhard-Strasse 100, 65199 Wiesbaden, Germany. ChriChri@t-online.de
Henrich
R
R
Mayer
G
G
Ell
C
C
D000328:Adult; D000818:Animals; D000909:Antibodies, Helminth / Q000097:blood; D001646:Bile / Q000469:parasitology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003937:Diagnosis, Differential; D004802:Eosinophilia / Q000175:diagnosis* / Q000276:immunology / Q000469:parasitology; D005210:Fasciola hepatica / Q000276:immunology; D005211:Fascioliasis / Q000175:diagnosis* / Q000469:parasitology / Q000635:transmission; D016266:Food Parasitology; D006801:Humans; D008099:Liver / Q000469:parasitology / Q000473:pathology; D008111:Liver Function Tests; D008279:Magnetic Resonance Imaging; D008297:Male; D010270:Parasite Egg Count; D014057:Tomography, X-Ray Computed
D000909:Antibodies, Helminth