Multiple hepatic nodules: rare manifestation of clonorchiasis.
A 38-year-old man was admitted due to intermittent right upper quadrant pain for 1 month. Leukocytosis with marked eosionphilia and elevated serum alkaline phosphatase were noted. Stool examinations revealed no parasites or ova. Ultrasonography and computed tomography disclosed multiple hepatic tumors. Biopsy of the hepatic tumor was performed due to non-conclusive imaging studies and revealed eosinophil infiltration in portal areas only. Endoscopic retrograde cholangiography showed mild dilatation with irregularity of bilateral intrahepatic ducts, compatible with chronic cholangitis. Bile was aspirated and biliary lavage with normal saline was performed during endoscopy-guided biliary cannulation. Microscopic examination of the aspirate showed the characteristic ova of Clonorchis sinensis. The patient received Praziquantel therapy for 1 day. Abdominal pain reduced in intensity gradually. Eosinophilia and multiple hepatic lesions resolved after adequate treatment of Clonorchis sinensis. The rare manifestation of multiple hepatic tumors in Clonorchis sinensis should be differentiated from other primary or metastatic neoplasms, while biliary lavage for parasite ova is a valuable diagnostic tool when stool examination is negative.
Liao
Wei-Chih
WC
Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
Wang
Hsiu-Po
HP
Chiu
Han-Mo
HM
Chang
Chi-Yang
CY
Lin
Jaw-Town
JT
D000328:Adult; D000818:Animals; D000871:Anthelmintics / Q000494:pharmacology / Q000627:therapeutic use; D001653:Bile Ducts, Intrahepatic / Q000469:parasitology / Q000473:pathology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003003:Clonorchiasis / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology*; D003004:Clonorchis sinensis / Q000187:drug effects; D006801:Humans; D008113:Liver Neoplasms / Q000469:parasitology / Q000473:pathology; D008297:Male; D011223:Praziquantel
D000871:Anthelmintics; D011223:Praziquantel