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Fascioliasis in Australian travellers to Bali

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Clinical record

Case 1

A 50-year-old woman presented with mild right upper quadrant (RUQ) pain 2 weeks after returning from Bali. This progressed over 1 month to severe epigastric pain, fever and rigors. She recalled eating mixed salad vegetables while in Bali. On ultrasound, multiple liver lesions were found and a diagnosis of pyogenic liver abscess was made. An infectious diseases (ID) physician was consulted. Her eosinophil count was raised (1.3 × 109/L [18%]; reference interval, 0.02–0.5 × 109/L). Microscopy of multiple stool samples did not show ova, cysts or parasites. Serological testing was positive for Fasciola hepatica (IgG optical density [OD], 3.0), and negative for Entamoeba spp. Hydatid antibodies were detected at a low titre (1 : 256) (this was considered to be a cross-reaction as confirmatory testing was negative). She had a good clinical response to oral triclabendazole 750 mg per month for 3 months.

Case 2

A 44-year-old woman developed diarrhoea during her stay in Bali, on a background of psoriatic arthropathy treated with leflunomide. While in Bali she frequently ate salads and uncooked vegetables. Her eosinophil count was normal (0.4 × 109/L [9%]). She developed RUQ pain 1–2 months after her return, and computed tomography (CT)…