Caballero-Alvarado José, Tapia-Beltrán Ana, Tirado-López Paula, Lau-Torres Víctor, Zavaleta-Corvera Carlos
Faculty of Medicine, Antenor Orrego Private University, Trujillo,13007, Peru.
Surgery Department, Regional Hospital of Trujillo, Trujillo 13007, Peru.
IDCases. 2025 Jun 17;41:e02287. doi: 10.1016/j.idcr.2025.e02287. eCollection 2025.
Fascioliasis is a parasitic zoonosis endemic to South America, caused by . During the acute migratory phase, the parasite affects the liver parenchyma, potentially leading to complications such as abscesses or necrosis. However, spontaneous rupture of a hepatic subcapsular hematoma related to infection is exceptionally rare and poorly documented in the literature. The aim of the present study is to report an unusual presentation of infection and to highlight the diagnostic relevance of parasitic etiologies in patients with eosinophilia and atypical hepatic imaging findings in endemic areas or in patients with travel history.
A 38-year-old man from a rural area endemic for Fasciola hepatica presented with progressive right upper quadrant abdominal pain, dizziness, and fatigue. Physical examination revealed pallor and localized tenderness. Laboratory studies showed severe normocytic anemia (hemoglobin: 6.8 g/dL) and marked eosinophilia (2600 cells/μL). Abdominal CT revealed a large subcapsular hepatic hematoma with hemoperitoneum. Given the eosinophilia and epidemiological background, a parasitic cause was suspected. Western blot serology confirmed infection. Liver function tests were normal, and there was no history of trauma or coagulopathy. The patient received conservative management, including fluid resuscitation, blood transfusion, and antiparasitic treatment with triclabendazole (10 mg/kg, repeated after 12 h). Follow-up imaging demonstrated gradual hematoma resolution. He was discharged after 10 days in stable condition and remained asymptomatic during outpatient follow-up.
This case underscores the need to consider parasitic infections in the differential diagnosis of unexplained hepatic lesions with eosinophilia, especially in endemic areas. Early recognition enables effective non-surgical management.
肝片吸虫病是一种在南美洲流行的寄生虫人畜共患病，由……引起。在急性移行期，寄生虫会影响肝实质，可能导致脓肿或坏死等并发症。然而，与……感染相关的肝包膜下血肿自发破裂极为罕见，文献记载也很少。本研究的目的是报告……感染的一种不寻常表现，并强调在流行地区嗜酸性粒细胞增多和肝脏影像学表现不典型的患者或有旅行史的患者中，寄生虫病因在诊断中的相关性。
一名来自肝片吸虫病流行农村地区的38岁男性，出现进行性右上腹腹痛、头晕和疲劳。体格检查发现面色苍白和局部压痛。实验室检查显示严重正细胞性贫血（血红蛋白：6.8 g/dL）和明显嗜酸性粒细胞增多（2600个细胞/μL）。腹部CT显示一个伴有腹腔积血的巨大肝包膜下血肿。鉴于嗜酸性粒细胞增多和流行病学背景，怀疑为寄生虫病因。蛋白质印迹血清学证实了……感染。肝功能检查正常，且无外伤或凝血功能障碍病史。患者接受了保守治疗，包括液体复苏、输血和用三氯苯达唑（10 mg/kg，12小时后重复给药）进行抗寄生虫治疗。随访影像学显示血肿逐渐消退。10天后他病情稳定出院，门诊随访期间无症状。
该病例强调在嗜酸性粒细胞增多的不明原因肝脏病变鉴别诊断中需要考虑寄生虫感染，尤其是在流行地区。早期识别有助于进行有效的非手术治疗。
