<i>Fasciola hepatica</i> infection complicated by hepatic tuberculosis: a case report
<p xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" dir="auto" id="d10561852e123">A 58-year-old male farmer living in Binchuan County, Dali, Yunnan Province, was admitted
to the First Affiliated Hospital of Dali University on July 20, 2022, with a complaint
of “right upper abdominal pain for more than two days”. Routine blood tests showed
elevated eosinophils counts (1.7 × 10
<sup>9</sup>/L), erythrocyte sedimentation rate (ESR, > 120 mm/h), and blood chemical tests showed
an increase in alanine aminotransferase (58 U/L), aspartate aminotransferase (74 U/L),
gamma-glutamyltransferase (66 U/L) and alkaline phosphatase concentrations (257 U/L).
Enzymelinked immunosorbent assay (ELISA) measured strongly positive serum IgM and
IgG antibodies against
<i>Fasciola hepatica</i>, and the T-SPOT. TB test was tested positive. Abdominal plain plus enhanced computed
tomography (CT) scans displayed the suspicion of hepatic malignancy with infectious
diseases that failed to be excluded. Liver histopathology revealed tunnel-like necrosis
and formation of foreign body granulomas, with
<i>F. hepatica</i> infection and tuberculosis that cannot be excluded. Acid-fast staining of the left
medial lobe liver specimen was positive, and
<i>Mycobacterium tuberculosis</i> complex DNA was detected. Metagenomic next-generation sequencing (mNGS) of liver
tissues detected 20
<i>M. tuberculosis</i> sequences and 15
<i>F. hepatica</i> sequences. The patient resided in Binchuan County, Dali Prefecture, Yunnan Province,
where fascioliasis is prevalent, and had a habit of consuming raw or undercooked vegetables.
Fascioliasis hepatica complicated by hepatic tuberculosis was diagnosed based on the
patient’s epidemiological history, symptoms and signs, and auxiliary diagnosis results.
Following deworming with triclabendazole at a dose of 15 mg/(kg·d) divided into 3
doses per day for 2 days and antitubercular therapy with rifampicin capsules (0.45
g once daily, adjusted for the patient’s weight of 48 kg), isoniazid tablets (0.3
g once daily), ethambutol tablets (0.75 g once daily) and pyrazinamide tablets (1.5
g once daily) for a week, the patient’s abdominal pain improved and was discharged
from hospital. At the 3-month follow-up, liver enzymes returned to normal, and at
the 6-month follow-up, the case had normal eosinophil counts, postoperative changes
in liver segment 4 and strip-like dense shadows in surgical areas on plain abdominal
CT scans, without remarkable progression.
</p><p xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="first" dir="auto" id="d10561852e145">
<b>【提要】</b> 患者, 男, 58岁, 云南大理宾川县人, 农民。2022年7月20日因“右上腹疼痛2天余”就诊于大 理大学第一附属医院。血常规示嗜酸粒细胞 (1.7 × 10
<sup>9</sup>/L)、血沉 (> 120 mm/h) 升高; 血生化示丙氨酸转氨酶 (58 U/L)、天冬氨酸转氨酶 (74 U/L)、γ-谷氨酰转移酶 (66 U/L)、碱性磷酸酶
(257 U/L) 升高; 血清ELISA 示 片形吸虫抗体IgM、IgG 均强阳性; 结核感染T 细胞阳性。腹部CT 平扫 + 增强考虑肝恶性肿瘤可能, 不排除感染
性疾病。肝脏组织病理结果示: 隧道样坏死及异物肉芽肿形成, 不排除肝片形吸虫感染及结核。左肝内侧叶标本 抗酸染色阳性, 结核分枝杆菌复合群DNA 阳性。肝脏组织宏基因组二代测序检出结核分枝杆菌序列20
条, 肝片 形吸虫序列15条。患者居住于云南省大理州宾川县 (片形吸虫病流行地区), 有喜食凉拌菜的生活习惯。结合患者 流行病学史、症状体征及相关辅助检验结果, 诊断为肝片形吸虫感染合并肝结核。予三氯苯达唑［15
mg/(kg•d), 分3 次服用, 连用2 d］、利福平胶囊 (按患者体质量48 kg计, 0.45 g, 每日1 次)、异烟肼片 (0.3 g, 每日1 次)、乙胺丁醇片
(0.75 g, 每日1 次)、吡嗪酰胺片 (1.5 g, 每日1 次) 进行驱虫及抗结核治疗, 治疗1 周后患者腹痛 好转出院。3个月后复查, 肝酶恢复正常。6个月后复查,
血常规示嗜酸粒细胞计数正常, 腹部CT平扫示肝S4段 术后改变, 术区可见条状致密影, 无明显进展。
</p>
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