Fasciola hepatica in a German Traveler Returning From Thailand

A 46-year-old man presented with nonspecific clinical signs including abdominal pain, diarrhea, fatigue, and nausea after returning from a trip to the northeast of Thailand 5 months ago. Laboratory diagnostics revealed a hypereosinophilia of 45% and slightly elevated cholestatic liver enzymes with an alkaline phosphatase of 163 U/L (40–129 U/L) and a gamma-glutamyl transferase of 109 U/L (−65 U/L); besides serological confirmation, repeated stool samples showed the eggs of Fasciola hepatica (miracidia of F. hepatica measuring 136 × 74 µm). The abdominal T1-weighted axial magnetic resonance imaging (MRI) showed multiple tubular, hypointense parenchymal lesions in liver segments II, IVa, and VII representing pyogenic microabscesses consistent with F. hepatica; mild dilatations of the intrahepatic bile duct with a mild reactive/inflammatory reaction were identified, but with no significant cholestasis (Figures 1 and 2). The patient was started on oral therapy with triclabendazol (10 mg/kg) single dose. Infections with the trematode F. hepatica are an extremely rare phenomenon among travelers, despite the high disease burden among local populations in endemic areas; therefore, F. hepatica infections should be kept in mind when dealing with patients with a relevant travel history suffering from nonspecific signs and hypereosinophilia.