Mulate ST, Gesese BD, Nur AM, Mengistu HB, Annose RT, Berga AE, Ulfata AL. Hepatic fascioliasis of emphasizing diagnostic difficulty and the need for high index of suspicion: Four case reports. World J Clin Cases 2025; 13(36): 113778 [DOI: 10.12998/wjcc.v13.i36.113778]
Corresponding Author of This Article
Sebhatleab T Mulate, MD, Assistant Professor, Department of Internal Medicine, Addis Ababa University, College of Health Science, Zambia Street, Addis Ababa 9086, Ethiopia. sebmulate@gmail.com
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Gastroenterology & Hepatology
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Case Report
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 26, 2025 (publication date) through Dec 25, 2025
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World Journal of Clinical Cases
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2307-8960
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Mulate ST, Gesese BD, Nur AM, Mengistu HB, Annose RT, Berga AE, Ulfata AL. Hepatic fascioliasis of emphasizing diagnostic difficulty and the need for high index of suspicion: Four case reports. World J Clin Cases 2025; 13(36): 113778 [DOI: 10.12998/wjcc.v13.i36.113778]
World J Clin Cases. Dec 26, 2025; 13(36): 113778 Published online Dec 26, 2025. doi: 10.12998/wjcc.v13.i36.113778
Hepatic fascioliasis of emphasizing diagnostic difficulty and the need for high index of suspicion: Four case reports
Sebhatleab T Mulate, Bishaw D Gesese, Abdulsemed Mohammed Nur, Hiwot B Mengistu, Rodas T Annose, Anteneh E Berga, Aga L Ulfata
Sebhatleab T Mulate, Bishaw D Gesese, Department of Internal Medicine, Addis Ababa University, College of Health Science, Addis Ababa 9086, Ethiopia
Abdulsemed Mohammed Nur, Rodas T Annose, Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa 1000, Ethiopia
Hiwot B Mengistu, Anteneh E Berga, Division of Infectious Diseases, Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa 1111, Ethiopia
Aga L Ulfata, Department of Radiology, Addis Ababa University, College of Health Science, Addis Ababa 9086, Ethiopia
Author contributions: Mulate ST contributed to the original draft writing, discussion, literature review, and editing; Nur AM contributed to the resources, supervision, index case management, editing, and validation; Annose RT contributed to index case management and supervision, Gesese BD contributed to the introduction, original draft writing, and editing; Mengistu HB contributed to index case management and editing; Berga AE contributed to supervision and index case management; Ulfata AL contributed to resources and discussion.
Informed consent statement: Verbal and written consent was taken from the patients and all images were shared with patients consent.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sebhatleab T Mulate, MD, Assistant Professor, Department of Internal Medicine, Addis Ababa University, College of Health Science, Zambia Street, Addis Ababa 9086, Ethiopia. sebmulate@gmail.com
Received: September 3, 2025 Revised: October 24, 2025 Accepted: December 8, 2025 Published online: December 26, 2025 Processing time: 113 Days and 15.4 Hours
Abstract
BACKGROUND
Fasciola hepatica (F. hepatica) (liver fluke) is a parasitic trematode that infects humans through the consumption of contaminated aquatic plants harboring the infective stage of the parasite. Despite being a neglected tropical disease, a World Health Organization report estimates that it affects approximately 2.4 million people worldwide, with high endemicity in regions characterized by poor sanitation and limited access to clean water. Clinical manifestations range from asymptomatic infection to severe complications such as liver abscess and multi-organ involvement.
CASE SUMMARY
We report 4 cases with varied and unusual presentations. Case 1: A 41-year-old woman with an initial presumptive clinical diagnosis of liver malignancy. Case 2: A 34-year-old woman who presented with urticaria and eosinophilia, initially suspected to be vasculitis. Case 3: A 67-year-old man who presented with dyspeptic symptoms, easy fatigability, headache, and fever. Case 4: A 60-year-old patient who presented with an eosinophilic liver abscess after prolonged antibiotic treatment failure.
CONCLUSION
Hepatic fascioliasis is frequently misdiagnosed due to its non-specific symptoms and limited diagnostic tools, especially in resource-limited settings. It is crucial to enhance awareness among healthcare professionals regarding its recognition and appropriate management. This case report aims to contribute to the growing body of literature on F. hepatica infection to facilitate timely diagnosis and empiric treatment with triclabendazole or nitazoxanide, as these are effective and reduce unnecessary interventions.
Core Tip: Hepatic fascioliasis remains a significant yet under-recognized cause of morbidity, particularly in endemic regions. Its variable presentations, prolonged clinical course, and limited clinician awareness—coupled with constrained access to serologic testing—often lead to misdiagnosis (e.g., as malignancy or bacterial abscess). This results in unnecessary costs and delayed treatment. A high index of clinical suspicion, a thorough inquiry about exposure and travel history, recognition of characteristic imaging findings, and correlation with eosinophilia are critical for a timely diagnosis. Early empiric treatment, which is simple and cost-effective, can prevent invasive procedures and reduce the patient burden.
