Korean J Parasitol.  2014 Apr;52(2):193-196.

A Case of Fasciola hepatica Infection Mimicking Cholangiocarcinoma and ITS-1 Sequencing of the Worm

• Kang BK
• Jung BK
• Lee YS
• Hwang IK
• Lim H
• Cho J
• Hwang JH
• Chai JY

Abstract

Fascioliasis is a zoonotic infection caused by Fasciola hepatica or Fasciola gigantica. We report an 87-year-old Korean male patient with postprandial abdominal pain and discomfort due to F. hepatica infection who was diagnosed and managed by endoscopic retrograde cholangiopancreatography (ERCP) with extraction of 2 worms. At his first visit to the hospital, a gallbladder stone was suspected. CT and magnetic retrograde cholangiopancreatography (MRCP) showed an intraductal mass in the common bile duct (CBD) without proximal duct dilatation. Based on radiological findings, the presumed diagnosis was intraductal cholangiocarcinoma. However, in ERCP which was performed for biliary decompression and tissue diagnosis, movable materials were detected in the CBD. Using a basket, 2 living leaf-like parasites were removed. The worms were morphologically compatible with F. hepatica. To rule out the possibility of the worms to be another morphologically close species, in particular F. gigantica, 1 specimen was processed for genetic analysis of its ITS-1 region. The results showed that the present worms were genetically identical (100%) with F. hepatica but different from F. gigantica.

Keyword

Fasciola hepatica; Fasciola gigantica; sheep liver fluke; bile duct cancer; molecular diagnosis; ITS-1

MeSH Terms

Aged, 80 and over
Animals
Base Sequence
Cholangiocarcinoma/diagnosis
Cholangiopancreatography, Magnetic Resonance
Common Bile Duct/*pathology
DNA, Helminth/*genetics
DNA, Intergenic/genetics
Diagnosis, Differential
Fasciola hepatica/*genetics
Fascioliasis/*diagnosis/parasitology
Humans
Male
Neglected Diseases/diagnosis/parasitology
Republic of Korea
Sequence Analysis, DNA
DNA, Helminth
DNA, Intergenic