Icterícia obstrutiva intermitente por Fasciolose hepática: tratamento clínico - Relato de caso

• DOI: https://doi.org/10.22533/at.ed.9481625010813

• Palavras-chave: Fasciolíase - Zoonose - Saúde pública

• Keywords: Fascioliasis - Zoonosis - Public health

• Abstract: A 75-year-old patient from the interior of Rio Grande do Sul was admitted to our service on 04/09/24 with upper abdominal pain and transient jaundice of 2 days evolution, total bilirubin (TB) of 9.14, transaminases > 3x the upper limit of normal, gamma glutamyltransferase of 840 and alkaline phosphatase of 188. Abdominal tomography (CT) with contrast on admission did not identify hepatobiliary alterations. A cholangiography resonance was performed, which identified a serpingiform liver in the posterior periphery of segment VI/VII. After diagnostic confirmation, treatment with nitazoxanide 500mg twice daily for 7 days was initiated. On April 24, 2024, the patient showed clinical and laboratory improvement. A repeat cholangiography scan showed signs of regression of focal inflammatory activity in the periphery of segment VI of the liver and a residual curvilinear line, with no evidence of common bile duct stones. He was then discharged for outpatient follow-up. Fascioliasis is a zoonosis caused by the trematode F. hepatica, whose intermediate hosts are mollusks (Lymnaea) and ruminants as definitive hosts. Humans can become accidental hosts by consuming water or vegetables contaminated with metacercariae. Because it is not a notifiable disease, the incidence of the disease in Brazil is unknown. A review identified 66 cases reported in Brazil from 1958 to 2022, with a higher incidence in the southern states. Clinically, it can be asymptomatic, acute, or chronic. The acute phase occurs 6 to 12 weeks after infection and presents with fever, abdominal pain, hepatomegaly, and eosinophilia. The chronic phase, occurring from 6 months to 10 years, presents with similar symptoms. A review of radiographic findings in fascioliasis observed that multiple small, branching, nodular lesions (up to 25 mm in diameter) were the most common findings; these often occur in the subcapsular area of the liver parenchyma. They most often appear hypoechoic on ultrasound, hypodense on CT, and hyperintense on T2-weighted images and hypointense on T1-weighted MRI. Peripheral enhancement on post-contrast images is characteristic. CT may demonstrate characteristic hypodense nodules or tortuous pathways due to parasite migration through the liver. Cholangiography and ERCP may demonstrate motile, sheet-like worms in the bile ducts and gallbladder.