Hepatic eosinophilic pseudotumor due to Fasciola hepatica infection mimicking intrahepatic cholangiocarcinoma: A case report

Table 1 Laboratory test findings upon admission

Parameter	Result
Blood test
White blood cells	9.71 K/µL
Eosinophils	35.3%
Neutrophils	39.1%
Hemoglobin	120 g/L
Hematocrit	37.4%
Aspartate aminotransferase	27.2 U/L
Alanine aminotransferase	30.4 U/L
Total bilirubin	6.0 μmol/L
Direct bilirubin	2.28 μmol/L
Carcinoembryonic antigen	< 0.5 ng/mL
Carbohydrate antigen 19-9	< 2.0 ng/mL
Diagnostic serum test
Hepatitis B surface antigen	Negative (0.27)
Quantitative hepatitis B surface antibody	91.48 mIU/mL
Hepatitis C virus antibody	Negative (0.11)
Fasciola sp. IgG	Positive (0.976)
Entamoeba histolytica IgG	Negative (0.08)
Toxocara IgG	Negative (0.17)
Strongyloides stercoralis IgG	Grayzone (0.26)

Note, there was a marked elevation in eosinophils, accounting for 35.3% of the total white blood cell count, while tumor markers such as carbohydrate antigen 19-9 and carcinoembryonic antigen were within normal limits. The positive serology for Fasciola hepatica indirectly suggests that the elevated eosinophil count may be related to this parasitic infection.

Table 2 Clinical timeline for hepatic eosinophilic pseudotumor misdiagnosed as intrahepatic cholangiocarcinoma

Timeframe	Event
1 month prior admission	Patient presented with recurring upper abdominal pain, fever with chills, and significant weight loss
Week 1	Patient underwent a clinical evaluation and basic laboratory tests, including complete blood count and tumor markers
Week 2	Abdominal CT and magnetic resonance imaging scans revealed a mass in the hepatic hilum, raising suspicion of intrahepatic cholangiocarcinoma
Week 3	Liver biopsies, performed twice, showed no malignant cells but revealed significant eosinophilic infiltration
Week 4	Serologic testing was positive for Fasciola hepatica; treatment with triclabendazole was initiated
6 months later	The patient exhibited marked symptom improvement, weight gain, and complete resolution of the hepatic mass on imaging studies. Furthermore, serologic testing for Fasciola sp. IgG yielded negative results, and stool examinations for parasitic identification were also negative

CT: Computed tomography.