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.

[1]  H. Ham,et al.  No Detection of Severe Fever with Thrombocytopenia Syndrome Virus from Ixodid Ticks Collected in Seoul , 2014, The Korean journal of parasitology.

[2]  T. Klein,et al.  Larval Chigger Mites Collected from Small Mammals in 3 Provinces, Korea , 2014, The Korean journal of parasitology.

[3]  Dongyou Liu,et al.  Molecular Detection of Human Parasitic Pathogens , 2012 .

[4]  S. Çetin,et al.  Clinical presentation and management of Fasciola hepatica infection: single-center experience. , 2011, World journal of gastroenterology.

[5]  A. Dalimi,et al.  Molecular Identification and Differentiation of Fasciola Isolates Using PCR- RFLP Method Based on Internal Transcribed Spacer (ITS1, 5.8S rDNA, ITS2) , 2011, Iranian journal of parasitology.

[6]  K. Kang,et al.  [Four cases of hepatic fascioliasis mimicking cholangiocarcinoma]. , 2005, The Korean journal of hepatology.

[7]  M. Arafa,et al.  A review on fascioliasis in Egypt. , 2002, Journal of the Egyptian Society of Parasitology.

[8]  J. Richter,et al.  The efficacy and tolerability of triclabendazole in Cuban patients with latent and chronic Fasciola hepatica infection. , 2000, The American journal of tropical medicine and hygiene.

[9]  M. Kiladze,et al.  Obstruction of common bile duct caused by liver fluke--Fasciola hepatica. , 2000, Sbornik lekarsky.

[10]  H. L. Viana,et al.  Biliary fascioliasis: diagnosis, treatment and follow-up by ERCP. , 1996, Gastrointestinal endoscopy.

[11]  John C Walker,et al.  Human ectopic fascioliasis in Australia: first case reports , 1992, The Medical journal of Australia.

[12]  宮崎 一郎.  An illustrated book of helminthic zoonoses , 1991 .

[13]  N. Han,et al.  The efficacy and safety of INTRON A in patients in Korea with chronic active hepatitis type B , 1990 .

[14]  C. W. Chan,et al.  5 Diseases caused by liver flukes and cholangiocarcinoma , 1987 .

[15]  C. W. Chan,et al.  Diseases caused by liver flukes and cholangiocarcinoma. , 1987, Bailliere's clinical gastroenterology.

[16]  S. Cho,et al.  [A Case Of Human Fascioliasis In Korea] , 1976, Kisaengch'unghak chapchi. The Korean journal of parasitology.