Date of admission: abdominal pain.
Care Center: Comandante Faustino Pérez Hospital.
Matanzas, Cuba.
History of the current disease: VAD patient, female, black race and 35 years old, coming from Pedro Betancourt municipality in Matanzas province-Cuba.
Teach regularly, lettuce and other wild plant products.
Drink water without boiling or purifying.
At the beginning of April 2011, she presented intense and constant pain throughout the abdomen, which after one week focused on the right epigastric and hypochondrium.
The pain was always accompanied by nausea, vomiting and general malaise.
During this period, the presence of a high number of diarrheic diarrheic, abundant in quantity, was found in the diarrheic, with a high number of cases in number, abundant in quantity, in the water and approximately one week (solving without intervention).
From the beginning of the process, fever of 37 to 38 degrees centigrade spread over a period of 8 weeks, until mid-May.
At the time of admission, cutaneous-mucosal stricture, globulous abdomen and pain upon superficial and deep fixation were observed, more intense in the right hypochondrium and epigastrium.
At 33 days after admission, hepatomegaly of approximately 8 cm was detected, but with a very painful surface, without stenosis.
The white blood cell count showed an overall count of 30,000/mm3 with 81%, hemoglobin 1 g/d and hematocrit 0.33 g/l.
Peripheral lamina: adequate platelets, moderate leukocyte count, marked hypochromia, normocytosis.
TGP: 85.5 u/l, TGO: 43 u/l, FA: 348, GGT: 80 u/l, serum amylase 63.3, LDH; 434 u/L.
In several fecal tests (performed all at different times, during April 2011 in the provincial reference laboratory in Parasitology, of the Provincial Center of Hygiene, Epidemiology and Direct Microbiology-Mat-Mat stool test)
Different tests were performed using the technique of concentration by simple sedimentation of conical cup, which were also negative.
The ultrasound examination showed diffuse hepatomegaly with predominance of the left lobe, which exceeded the breast line on that side.
It was also reported that texture was altered with diffuse appearance and increased echogenicity in venous vessels and increased connective tissue.
The gallbladder had walls and dilatation of intra or extra hepatic pathways was not demonstrated.
Computed tomography: An enlarged liver with a heterogeneous appearance and multiple images of irregular contours hypnosis distributed throughout the parenchyma.
Alithiasic bladder of walls.
Bazo, pancreas and kidneys were unchanged.
On the Izquierda lung base, a small pleural effusion of the malformation is observed.
Laparoscopic lobule: enlargement of the liver that is brownish red with irregular surface and rounded white colored lesions surrounded by a red zone on the surface of both.
The existence of a blunt edge with increased consistency was demonstrated.
Bazo normal size.
White and empty subhepatic biliary tract.
The detection of excretory-secretory antigens of F. hepatica (ELISA) carried out in the first week of June 2011 in the reference laboratory of Pedro Kouri Tropical Medicine Institute in Havana- Cuba was not positive.
Detection of specific IgG antibodies against the parasite was positive.
With the clinical and epidemiological information received and considering the results provided by the different diagnostic means, the responsible medical team decided to treat the patient as a case of fasciolosis and administered a single dose of 20 mg/kg of oral fat.
On the third day after receiving treatment, discharge was decided and the patient was referred to her health area where she remained under medical observation by her general physician.
Every two months blood tests, liver transaminases and amylasemia were performed, parameters that returned to normal at the fourth month.
Likewise, stool tests were performed by conical cup in the reference provincial laboratory with always negative results.
The detection of specific IgG antibodies against the parasite showed a downward trend when repeated two and six months after treatment with trilabendazole and the detection of excretory-secretory antigens of F. hepatica treatment was negative at two months.
Six months after treatment the patient had no symptoms and/or signs suggesting the presence of seizures.
He is currently in excellent health and has returned to his daily activities.
