【Presentation of a Case 】
A 38-year-old male patient was
admitted because of abdominal pain at the right upper quadrant
for about one month.
He had been previously well and
worked in Canton Province of the mainland China over the past
years. About one month prior to this admission, he began to
feel pain at the right upper quadrant. The characters of pain
were dull and intermittent with radiation to the right flank
region. There was no fever, jaundice, vomiting, weight change,
or respiratory symptoms. He was seen at a clinic in China
where abdominal sonography revealed gall stones. He was
treated with herbal remedies with mild improvement of the
symptoms. About one week earlier before this entry, he came
back to Taiwan and experienced similar bouts of symptoms
associated with fever and chills for which he sought medical
help at this hospital.
He denied exposure to chemical
agents, taking herbal medicines after the first treatment in
China, or consumption of alcohol. He recalled ingestion of
uncooked freshwater fish for three times about two to three
months earlier before this admission.
At admission, blood pressure
was 100/70 mmHg, temperature 36.5℃, pulse rate 60 beats
per minute, and respiratory rate,16 per minute. He was not
in acute distress and in good nutritional status.
Skin examination was normal. Physical examinations
were unremarkable and there was no abdominal tenderness or
organomegaly.
Complete blood counting at
admission revealed hematocrit 40.6% and WBC 20,790/μl with 68% eosinophilia. Liver function
tests revealed total bilirubin
0.4 mg/dL, aminotransferase 46 IU/L, and alkaline
phosphatase 390 IU/L. Stool examination for parasites were repeatedly negative. Computed
tomography (CT) disclosed multiple tumors of low densities at the segment 3 (2
cm in diameter), segment 4 (2
cm), and segment 6 and 7 (4 cm). Portal veins were
patent.
Pathology of the liver biopsy
specimens showed prominent eosinophilic infiltration and mild
lymphocyte infiltration in portal area and sinusoids. Bone
marrow biopsy showed an interstitial infiltration of
eosinophils accounting for about 10% of the mononuclear cells.
To obtain bile for parasitic examination, endoscopic
retrograde cholangiopancreatography (ERCP)was performed to
yield 15 ml bile. A few ova of Clonorchis sinensis
was identified. He was given praziquantel at a daily dose
of 75 mg/kg for one day. Subsequent follow-up revealed resolving
eosinophilia. The liver CT would be followed 3-6 month later
on an outpatient basis.
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