article · Journal of Medical Case Reports
Fascioliasis is an endemic zoonotic infection in parts of Ethiopia that typically presents with hepatobiliary symptoms, whilst vascular complications are rare. A clinical case from rural Ethiopia involved a 58-year-old woman with a history of sheep farming and raw vegetable consumption who initially presented with deep vein thrombosis. Despite anticoagulation, she subsequently developed severe abdominal pain, anaemia, a large 732-millilitre hepatic subcapsular haematoma, portal vein thrombosis, and extended venous thrombosis. Although repeated stool examinations for parasite eggs were negative and serology was unavailable, high persistent eosinophilia and exposure history strongly indicated fascioliasis. Management combined blood transfusion, careful anticoagulation, and empiric triclabendazole. Follow-up imaging at six months confirmed the gradual resolution of the haematoma, thrombosis, and clinical symptoms, highlighting that empiric antiparasitic treatment and supportive care can achieve favourable outcomes in suspected cases.
Fascioliasis is frequently overlooked when presenting with atypical vascular complications like severe thrombosis and internal bleeding. In rural endemic regions where advanced laboratory tests such as serology are unavailable, recognising clinical markers like persistent eosinophilia and exposure history enables healthcare workers to initiate timely empiric treatment, preventing life-threatening outcomes in vulnerable patients.
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Fascioliasis, a zoonotic infection caused by Fasciola hepatica , is endemic in parts of Ethiopia. While hepatobiliary symptoms are common, vascular complications such as portal vein thrombosis (PVT) and deep vein thrombosis (DVT) are rarely reported. We describe a case of suspected fascioliasis presenting with a large hepatic subcapsular hematoma, PVT, and extensive DVT in a patient from a rural endemic area with a history of sheep farming. A 58-year-old woman from a rural highland area of Ethiopia, with a history of sheep farming and frequent consumption of inadequately cleaned raw vegetables, initially presented with progressive right lower limb swelling due to proximal deep vein thrombosis (DVT). One month later, despite therapeutic anticoagulation, she developed severe right upper quadrant abdominal pain and symptoms of anemia. Triphasic abdominal computed tomography (CT) revealed a large right hepatic subcapsular hematoma (approximately 732 mL), multifocal intraparenchymal lesions, portal vein thrombosis, and extension of thrombosis to the right external and common iliac veins. No serological testing for Fasciola hepatica was performed, and repeated stool examinations for eggs were negative. Persistent eosinophilia (peaking at 32.7%), combined with her occupational exposure to sheep and dietary history, raised strong clinical suspicion for fascioliasis despite repeatedly negative stool examinations. She was managed with blood transfusion, careful anticoagulation, and empiric triclabendazole therapy (400 mg daily for two days). Her symptoms, eosinophilia, hematoma, and thrombi showed gradual resolution on follow-up imaging at six months. Fascioliasis should be considered in patients from endemic areas who present with unexplained eosinophilia, hepatic abnormalities, and thrombotic events, even when parasitological tests are negative and serological confirmation is unavailable. A history of sheep farming or raw vegetable consumption provides important diagnostic clues. Prompt recognition and empiric antiparasitic treatment, along with supportive care, can lead to favorable outcomes.
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DOI: 10.1186/s13256-026-06525-7
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