A 31 yo F with liver and colon lesions which was diagnosed ectopic fascioliasis and remained well after treatment.

1. CASE 409: ECTOPIC FASCIOLIASIS, LÊ ĐÌNH VĨNH PHÚC,
PHẠM CHÍ TOÀN, VÕ NGUYỄN THÀNH NHÂN, MEDIC
MEDICAL CENTER, HCMC, VIETNAM
Female patient, 31 year-old, accountant, in Gia Lai province. Onset 2 months with
scattered bodyitching, no skin lesions, no fever, no abdominal pain. A private
clinic in Gia Lai, with blood tests, diagnosed Toxocara sp infection, and gave her
albendazole 800mg/day x 21 days. No itching, she went down to an another
private clinic in Quy Nhon province, and with another blood tests, she
was diagnosed infected Cysticercosis, treated with albendazole 800mg/day x 10
days. Then appearing right abdominal pain, ultrasound suspected liver damage
caused by Fasciola spp. She went to Institute of Parasitology and Entomology in
Quy Nhon province and then came to Medic Hoa Hoa in Ho Chi Minh city.
Ultrasound detected right liver lesion with mixed echo, d = 5 cm, clear border,
within a few hypoechoic nodules, and no liver tissue edema around. (Fig 1, 2).
Further ultrasound detected colon wall thickness at liver region, hypoechoic, not
lumen narrowing. (Fig 3).
Endoscopyshowed transverse colitis.

2. Blood tests: WBC 14,500 cells/mm3 (Neutrophil 61.9%, Eosinophil 15.8%),
hsCRP 14.53 mg/L. HBsAg (-), antiHCV (-), AFP (-), CEA (-), Fasciola sp IgG
(+), stoolexam (-).
Biopsy tissue in colon lesion was done and microscopic report was eosinophil
mucosa colitis.
MSCT CE presented liver lesion d = 4x6cm and transverse colon lesion with wall
thickness d = 20mm (Fig 5, 6).

3. We diagnosed: liver abscess and pseudotumor colitis by Fasciola spp (Ectopic
Fascioliasis), treated with Triclabendazol 10mg/kg/day x 2 days.
Re-examination 4 weeks later, WBC 8,800 cells/mm3 (Eosinophil 2.5%), hsCRP
1.3 mg/L.
Liver lesion in ultrasound and MSCT, wall thickness d = 8mm in MSCT (Fig 8, 9).

4. We represented an ectopic Fascioliasis case with hepatic and transverse colon
lesions and an undifferential serodiagnosis. Endoscopic biopsyresult helped ruling
out a colon tumor. But based on ultrasound findings of liver and colon lesions
which were confirmed by MSCT we could chosed a concordantdiagnosis for this
case.