Volume 100, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



A 23-year-old recent emigrant from Afghanistan presented in August 2017 with severe wheezing and dyspnea that required hospital admission. Her illness was associated with marked peripheral blood eosinophilia (9,900–15,600/µL; 45.2–68%), as well as mild nausea, epigastric pain, and decreased appetite. She had lived until 3 months earlier in close proximity to cattle in her home in Kabul and did not recall eating watercress or other leafy plants associated with transmission. Computerized tomography scanning showed bilateral ground-glass lung consolidations and multiple distinctive hypo-attenuating linear, tubuliform, and nodular liver lesions, including a large subcapsular hematoma. Numerous tests for rheumatological and malignant disorders were negative. infestation was suspected on epidemiological, clinical, and radiographic grounds, and was confirmed by immunoblotting at the Centers for Disease Control (CDC). Multiple stool ova and parasite examinations were negative and endoscopic retrograde cholangiopancreatography did not identify trematodes. Her acute respiratory illness resolved with asthma-targeted therapies and her eosinophilia resolved with triclabendazole, which was obtained from CDC via an FDA Investigational New Drug application. Fascioliasis is uncommon in the United States, but the prolonged warfare and civil strife in Afghanistan and adjacent areas may lead to increased incidence outside the endemic region. Her case also demonstrates how hepatic imaging features of fascioliasis can be pathognomonic in clinical scenarios with eosinophilia and appropriate epidemiology and clinical features. We also highlight her relatively unusual presentation with symptoms of Loeffler-like syndrome alone.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Mas-Coma S, Bargues MD, Valero MA, , 2018. Human fascioliasis infection sources, their diversity, incidence factors, analytical methods and prevention measures. Parasitology 145: 16651699. [Google Scholar]
  2. Ashrafi K, Bargues MD, O’Neill S, Mas-Coma S, , 2014. Fascioliasis: a worldwide parasitic disease of importance in travel medicine. Travel Med Infect Dis 12: 636649. [Google Scholar]
  3. Webb CM, Cabada MM, , 2018. Recent developments in the epidemiology, diagnosis, and treatment of Fasciola infection. Curr Opin Infect Dis 31: 409414. [Google Scholar]
  4. Qureshi AW, Tanveer A, Mas-Coma S, , 2016. Epidemiological analysis of human fascioliasis in northeastern Punjab, Pakistan. Acta Trop 156: 157164. [Google Scholar]
  5. Furst T, Duthaler U, Sripa B, Utzinger J, Keiser J, , 2012. Trematode infections: liver and lung flukes. Infect Dis Clin North Am 26: 399419. [Google Scholar]
  6. Mas-Coma S, , 2005. Epidemiology of fascioliasis in human endemic areas. J Helminthol 79: 207216. [Google Scholar]
  7. Shin SH, Hsu A, Chastain HM, Cruz LA, Elder ES, Sapp SG, McAuliffe I, Espino AM, Handali S, , 2016. Development of two FhSAP2 recombinant-based assays for immunodiagnosis of human chronic fascioliasis. Am J Trop Med Hyg 95: 852855. [Google Scholar]
  8. Maco V, Marcos L, Delgado J, Herrera J, Nestares J, Terashima A, Samalvides F, Gotuzzo E, , 2015. Efficacy and tolerability of two single-day regimens of triclabendazole for fascioliasis in Peruvian children. Rev Soc Bras Med Trop 48: 445453. [Google Scholar]
  9. Kaya M, Bestas R, Cetin S, , 2011. Clinical presentation and management of Fasciola hepatica infection: single-center experience. World J Gastroenterol 17: 48994904. [Google Scholar]
  10. Marcos LA, 2008. Natural history, clinicoradiologic correlates, and response to triclabendazole in acute massive fascioliasis. Am J Trop Med Hyg 78: 222227. [Google Scholar]
  11. Bayhan GI, Batur A, Taylan-Ozkan A, Demiroren K, Beyhan YE, , 2016. A pediatric case of fascioliasis with eosinophilic pneumonia. Turk J Pediatr 58: 109112. [Google Scholar]
  12. Aliaga L, Diaz M, Quiroga J, Arejola JM, Prieto J, , 1984. Eosinophilic pulmonary disease caused by Fasciola hepatica. Description of a case and review of the literature. Med Clin (Barc) 82: 764767. [Google Scholar]
  13. Musa D, Godbole G, Chiodini PL, Phillips R, , 2013. Unusual case of a lung abscess. BMJ Case Rep. doi: 10.1136/bcr-2012-008306. [Google Scholar]
  14. Patel NU, Bang TJ, Dodd GD, 3rd, 2016. CT findings of human Fasciola hepatica infection: case reports and review of the literature. Clin Imaging 40: 251255. [Google Scholar]
  15. Rodriguez Carnero P, Hernandez Mateo P, Martin-Garre S, Garcia Perez A, Del Campo L, , 2017. Unexpected hosts: imaging parasitic diseases. Insights Imaging 8: 101125. [Google Scholar]
  16. Kelley JM, Elliott TP, Beddoe T, Anderson G, Skuce P, Spithill TW, , 2016. Current threat of triclabendazole resistance in Fasciola hepatica. Trends Parasitol 32: 458469. [Google Scholar]
  17. Mas-Coma S, Angles R, Esteban JG, Bargues MD, Buchon P, Franken M, Strauss W, , 1999. The northern Bolivian Altiplano: a region highly endemic for human fascioliasis. Trop Med Int Health 4: 454467. [Google Scholar]

Data & Media loading...

  • Received : 30 Jul 2018
  • Accepted : 21 Nov 2018
  • Published online : 09 Jan 2019

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error