Hepatic Fascioliasis: A Rare Cause of Portal Vein Thrombosis

Fascioliasis is a zoonosis caused by the trematodes Fasciola hepatica or Fasciola gigantica, acquired through ingestion of contaminated water or aquatic plants. Clinically, it presents with an acute phase characterized by fever, abdominal pain, and hepatomegaly, and a chronic phase, which is usually asymptomatic. Portal vein thrombosis (PVT) is a rare complication, not previously described among the approximately 30 cases of fascioliasis reported in Portugal. We describe a 48-year-old man who had been on a recent trip to Cape Verde and consumed unpackaged watercress. He was admitted with fever and right upper quadrant pain; laboratory results showed eosinophilia and recurrence of a hepatic abscess associated with PVT. Positive Fasciola hepatica serology and immunoblot confirmed the diagnosis. Treatment with triclabendazole led to a significant reduction of the abscess after three months. Fascioliasis should be considered in the differential diagnosis of hepatic abscesses in patients with epidemiological risk factors and poor response to conventional antibiotic therapy, to prevent possible complications.