[Human infection with Dicrocoelium dendriticum].

UNLABELLED

MEDICAL HISTORY AND PHYSICAL EXAMINATION: A 36-year-old German reported having had chronic-relapsing diarrhea, right upper abdominal pain and weight-loss for about two years. His last journey had taken him to Morocco three and a half years ago. The physical examination was unremarkable except for an abdominal tenderness to palpation in the right upper quadrant. LABORATORY: The serum level of bilirubin was slightly raised to 1.13 mg/dl (<1.10 mg/dl) and the level of IgE was raised to 253 U/ml (<100 U/ml). All other laboratory findings were within normal limits. Stool examinations showed eggs of Dicrocoelium dendriticum. The abdominal ultrasound was unremarkable except for mild steatosis.

TREATMENT AND COURSE

The patient denied consumption of liver or liver-products within the past weeks. Spurious infection due to eating infected liver could thus be excluded. The patient was treated for dicrocoeliasis with praziquantel (3 x 600 mg/day for three days). Further stool examinations for parasites were negative. Since the patient still had gastrointestinal discomfort, we decided to give a further therapy with triclabendazole (700 mg, single dose). Five weeks after the second treatment the patient was almost free of symptoms and stool examinations for parasites remained negative.

CONCLUSION

Dicrocoeliasis can be associated with chronic diarrhea. Stool examinations for parasites are very important in patients with gastrointestinal symptoms.