A case of Fasciola hepatica infection mimicking cholangiocarcinoma and ITS-1 sequencing of the worm.
Fascioliasis is a zoonotic infection caused by Fasciola hepatica or Fasciola gigantica. We report an 87-year-old Korean male patient with postprandial abdominal pain and discomfort due to F. hepatica infection who was diagnosed and managed by endoscopic retrograde cholangiopancreatography (ERCP) with extraction of 2 worms. At his first visit to the hospital, a gallbladder stone was suspected. CT and magnetic retrograde cholangiopancreatography (MRCP) showed an intraductal mass in the common bile duct (CBD) without proximal duct dilatation. Based on radiological findings, the presumed diagnosis was intraductal cholangiocarcinoma. However, in ERCP which was performed for biliary decompression and tissue diagnosis, movable materials were detected in the CBD. Using a basket, 2 living leaf-like parasites were removed. The worms were morphologically compatible with F. hepatica. To rule out the possibility of the worms to be another morphologically close species, in particular F. gigantica, 1 specimen was processed for genetic analysis of its ITS-1 region. The results showed that the present worms were genetically identical (100%) with F. hepatica but different from F. gigantica.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 463-707, Korea.
Bong Kyun
BK
Kang
Department of Parasitology and Tropical Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea.
Bong-Kwang
BK
Jung
Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 463-707, Korea.
Yoon Suk
YS
Lee
Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 463-707, Korea.
In Kyeom
IK
Hwang
Department of Parasitology and Tropical Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea.
Hyemi
H
Lim
Department of Parasitology and Tropical Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea.
Jaeeun
J
Cho
Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 463-707, Korea.
Jin-Hyeok
JH
Hwang
Department of Parasitology and Tropical Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea.
Jong-Yil
JY
Chai
D000369:Aged, 80 and over; D000818:Animals; D001483:Base Sequence; D018281:Cholangiocarcinoma / Q000175:diagnosis; D049448:Cholangiopancreatography, Magnetic Resonance; D003135:Common Bile Duct / Q000473:pathology*; D018509:DNA, Helminth / Q000235:genetics*; D021901:DNA, Intergenic / Q000235:genetics; D003937:Diagnosis, Differential; D005210:Fasciola hepatica / Q000235:genetics*; D005211:Fascioliasis / Q000175:diagnosis* / Q000469:parasitology; D006801:Humans; D008297:Male; D058069:Neglected Diseases / Q000175:diagnosis / Q000469:parasitology; D056910:Republic of Korea; D017422:Sequence Analysis, DNA
D018509:DNA, Helminth; D021901:DNA, Intergenic
Fasciola gigantica; Fasciola hepatica; ITS-1; bile duct cancer; molecular diagnosis; sheep liver fluke