title: Clonorchis sinensis ova in bile juice cytology from a patient with severe hyperbilirubinemia and portal vein thrombosis.
abstract: Infection with the trematode Clonorchis sinensis is the most common human fluke infection in East Asian populations. Although this infection is associated with obstructive jaundice or choledocholithiasis, portal vein thrombosis has not been reported. Here, we report the first case of a 60-year-old man who had both C. sinensis infection and portal vein thrombosis with severe hyperbilirubinemia (75.4 mg/dl). He initially presented with abdominal pain and jaundice. Computed tomography revealed gallstones, common bile duct calculus, and thrombus in the left main branch of the portal vein. A nasobiliary tube was inserted under endoscopic retrograde cholangiography. Cytology of the bile juice revealed many C. sinensis eggs. The abdominal pain and jaundice improved following choledocholithotomy and combination treatment with a chemotherapeutic agent and anti-coagulant. This case suggests that inflammation around the portal vein as a result of C. sinensis infection has the potential to evoke portal vein thrombosis. Such cases should be treated with both a chemotherapeutic agent and anti-coagulant therapy. In conclusion, the possibility of infection with C. sinensis should be considered in patients presenting with hyperbilirubinemia and portal vein thrombosis, particularly in East Asian populations.
authors.affiliation: Department of Surgery, Tokyo Metropolitan Health and Medical Corporation Toshima Hospital, Tokyo, 173-0015, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Fujiya
authors.affiliation: Department of Surgery, Tokyo Metropolitan Health and Medical Corporation Toshima Hospital, Tokyo, 173-0015, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Ganno
authors.affiliation: Department of Surgery, Tokyo Metropolitan Health and Medical Corporation Toshima Hospital, Tokyo, 173-0015, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ando
authors.affiliation: Department of Pathology, Tokyo Metropolitan Health and Medical Corporation Toshima Hospital, Tokyo, 173-0015, Japan.
authors.forename: Ja-Mun
authors.initials: JM
authors.lastname: Chong
mesh_terms: D000818:Animals; D001646:Bile / Q000166:cytology / Q000469:parasitology*; D003003:Clonorchiasis / Q000150:complications / Q000175:diagnosis* / Q000469:parasitology; D003004:Clonorchis sinensis / Q000302:isolation & purification*; D006801:Humans; D006932:Hyperbilirubinemia / Q000150:complications / Q000175:diagnosis* / Q000469:parasitology; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000473:pathology*; D020246:Venous Thrombosis / Q000150:complications / Q000175:diagnosis* / Q000469:parasitology
keywords: Clonorchis sinensis; anti-coagulant therapy; choledocholithiasis; endoscopic retrograde cholangiography; jaundice