Hepatic eosinophilic pseudotumor due to Fasciola hepatica infection mimicking intrahepatic cholangiocarcinoma: A case report

Figure 1 Imaging characteristics of the hepatic lesion at the time of admission. A-C: Contrast-enhanced computed tomography scans in the venous phase demonstrated a lesion in the hepatic hilum, specifically in segment IV, with features suggestive of biliary involvement and invasion of the gallbladder; D: Magnetic resonance imaging also revealed similar characteristics.

Figure 2 Marked eosinophil infiltration observed on a hematoxylin and eosin-stained liver biopsy specimen. The biopsy showed dense infiltration of inflammatory cells, including lymphocytes and a significant number of eosinophils (orange arrows), in the periportal and lobular areas at various magnifications. A: 4 × magnification; B and C: 10 × magnification; D: 40 × magnification. No evidence of tumor tissue nor of malignant lesions was observed.

Figure 3 Temporal response of eosinophil count following triclabendazole treatment in a patient with hepatic eosinophilic pleural effusion secondary to Fasciola hepatica infection. The dynamic changes in eosinophil levels are shown. A marked reduction of eosinophil levels occurred after a single dose of triclabendazole, highlighting the efficacy of triclabendazole in the therapeutic management of parasitic hepatic eosinophilic pseudotumor.

Figure 4 Morphological changes of the hepatic hilum lesion on computed tomography scans post-treatment. A: The hepatic lesion in segment IV was initially suspected to be a biliary tumor; B: Three months after a single dose of triclabendazole, the lesion showed no features of a biliary neoplasm. Only a few small, low-attenuation lesions remained in both liver lobes, with no localization to the hepatic hilum; C: By 6 months post-treatment, the original lesion was nearly resolved, and the gallbladder showed no signs of tumor invasion. ACE: Arterial phase contrast enhanced; Non-CE: Non-contrast enhanced; VCE: Venous phase contrast enhanced.