Unknown aetiology of acute hepatitis: invasive liver flukes

Document Type : Case Reports

Authors

1 Assiut University, Internal Medicine Department, Gastroenterology Unit, Egypt.

2 Assiut University Internal Medicine Department, Gastroenterology Unit, Egypt.

Abstract

Background
Fasciola hepatica is a rare infectious zoonotic disease that seldom manifests as acute hepatitis. We present a case from Upper Egypt, specifically in Manfalout, Assiut, a region known to be endemic for fascioliasis. The patient, a 25-year-old male, displayed symptoms such as anorexia, vomiting, malaise, right hypochondrial pain, and fever, and was initially diagnosed with acute hepatitis. We carefully examined a patient with isolated acute hepatitis who had high levels of ALT and AST and normal levels of bilirubin and ALP to rule out viral hepatitis, autoimmune hepatitis, and Wilson's disease. Radiological findings, including abdominal ultrasound and MRCP, revealed mild hepatomegaly and a thick gallbladder wall with no dilated biliary channels. There was eosinophilia, elevated C-reactive protein, and a high titre of fasciola antibody, suggesting fascioliasis. A single dose of albendazole at 10 mg/kg showed a significant response, resulting in an improvement in liver enzymes and a marked improvement in all reported manifestations.

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Peer-Reviewers: Ahmed Fathy (Professor of Internal Medicine), Ahmed Gad (Professor of Internal Medicine), Nevin Fouad (Professor of Internal Medicine). E- Editor: Salem Y Mohamed, Emad Fawzi Hamed. This work was conducted in accordance with the CARE guidelines. Copyright ©. This open-access article is distributed under the Creative Commons Attribution License (CC BY). The use, distribution, or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited. The original publication in this journal is cited by accepted academic practice. No use, distribution, or reproduction is permitted without complying with these terms. Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent their affiliated organizations or those of the publisher, the editors, or the reviewers. Any product evaluated in this article or claim that its manufacturer may make is not guaranteed or endorsed by the publisher. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Declaration of competing interests There are no conflicts of interest related to this study.

Acknowledgments: The authors express their heartfelt gratitude to the resident doctors in the Internal Medicine Department, Gastroenterology Unit, at Al-Raghi Hospital—Dr. Dina Sameh, Dr. Flobater Talaat, Dr. Nardine Nady, and Dr. Demina Adel—for their committed contributions to patient management. We obtained written consent from the patient. Author contributions: Bahaa Osman Taha contributed to the conception, design, writing, and data analysis of the study. Essam Abdelmohsen contributed to the investigation, material preparation, and data collection. All the authors have read and approved the final manuscript. The patient gave written consent to participate in the study. The data are available as requested.

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