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Despite its status as a neglected tropical disease affecting millions worldwide, clinical manifestations vary from asymptomatic infection to serious complications including liver abscess and multiorgan involvement. CASE SUMMARY: Four cases demonstrate unusual, varied presentations leading to initial diagnostic errors, including suspected liver malignancy, vasculitis, dyspepsia with systemic symptoms, and eosinophilic liver abscess after prolonged antibiotic failure. CONCLUSION: Misdiagnosis results from nonspecific features and limited diagnostic tools; heightened suspicion and timely empiric therapy can reduce delays and unnecessary interventions.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/hepatic-fascioliasis-of-emphasizing-diagnostic-difficulty-and-the-need-for-high-index-of-suspicion-four-case-reports/406821/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/hepatic-fascioliasis-of-emphasizing-diagnostic-difficulty-and-the-need-for-high-index-of-suspicion-four-case-reports/406821.png","ImageObject",300,407,{"name":92,"@type":93},"Alexandar","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-06","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":34},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why is hepatic fascioliasis difficult to diagnose?","Question",{"text":112,"@type":113},"It is frequently misdiagnosed because symptoms are non-specific and diagnostic tools are limited, especially in resource-limited settings. Variable presentations can mimic other conditions such as malignancy or bacterial abscess.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What varied presentations are described in the four cases?",{"text":117,"@type":113},"Case presentations included suspected liver malignancy, urticaria with eosinophilia initially thought to be vasculitis, dyspeptic symptoms with systemic complaints, and eosinophilic liver abscess after prolonged antibiotic treatment failure.",{"name":119,"@type":110,"acceptedAnswer":120},"What approach helps achieve timely diagnosis and treatment?",{"text":121,"@type":113},"A high index of clinical suspicion, careful history of exposure and travel, recognition of characteristic imaging, and correlation with eosinophilia are emphasized. Early empiric treatment with triclabendazole or nitazoxanide is noted as effective and can reduce unnecessary interventions.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},406821,1791083891,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":34,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},962090768658,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","| W | J | C | C | World Journal of\u003Cbr>Clinical Cases |\n| --- | --- | --- | --- | --- |\n\nSubmit a Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Clin Cases 2025 December 26; 13(36): 113778  \nDOI: 10.12998/wjcc.v13.i36.113778 ISSN 2307-8960 (online)  \nCASE REPORT  \nHepatic fascioliasis of emphasizing diagnostic difficulty and the need for high index of suspicion: Four case reports  \nSebhatleab T Mulate, Bishaw D Gesese, Abdulsemed Mohammed Nur, Hiwot B Mengistu, Rodas T Annose, Anteneh E Berga, Aga L Ulfata  \nSpecialty type: Gastroenterology and hepatology  \nProvenance and peer review:  \nUnsolicited article; Externally peer reviewed.  \nPeer-review model: Single blind  \nPeer-review report’s classification Scientific Quality: Grade B, Grade B, Grade C  \nNovelty: Grade B, Grade B, Grade D  \nCreativity or Innovation: Grade B, Grade B, Grade D  \nScientific Significance: Grade B, Grade B, Grade D  \nP-Reviewer: Bao YL, PhD, Professor, China; Huang JM, Assistant Professor, Deputy Director, China; Rusman RD, MD, Assistant Professor, Indonesia  \nReceived: September 3, 2025  \nRevised: October 24, 2025  \nAccepted: December 8, 2025  \nPublished online: December 26, 2025  \nProcessing time: 113 Days and 17 Hours  \nSebhatleab T Mulate, Bishaw D Gesese, Department of Internal Medicine, Addis Ababa University, College of Health Science, Addis Ababa 9086, Ethiopia  \nAbdulsemed Mohammed Nur, Rodas T Annose, Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa 1000, Ethiopia  \nHiwot B Mengistu, Anteneh E Berga, Division of Infectious Diseases, Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa 1111, Ethiopia  \nAga L Ulfata, Department of Radiology, Addis Ababa University, College of Health Science, Addis Ababa 9086, Ethiopia  \nCorresponding author: Sebhatleab T Mulate, MD, Assistant Professor, Department of Internal Medicine, Addis Ababa University, College of Health Science, Zambia Street, Addis Ababa 9086, [Ethiopia.](Ethiopia. sebmulate@gmail.com)[ sebmulate@gmail.com](Ethiopia. sebmulate@gmail.com)  \nAbstract  \nBACKGROUND  \nFasciola hepatica (F. hepatica) (liver fluke) is a parasitic trematode that infects humans through the consumption of contaminated aquatic plants harboring the infective stage of the parasite. Despite being a neglected tropical disease, a World Health Organi-zation report estimates that it affects approximately 2.4 million people worldwide, with high endemicity in regions characterized by poor sanitation and limited access to clean water. Clinical manifestations range from asymptomatic infection to severe complications such as liver abscess and multiorgan involvement.  \nCASE SUMMARY  \nWe report 4 cases with varied and unusual presentations. Case 1: A 41-year-old woman with an initial presumptive clinical diagnosis of liver malignancy. Case 2: A 34-year-old woman who presented with urticaria and eosinophilia, initially suspected to be vasculitis. Case 3: A 67-year-old man who presented with dyspeptic symptoms, easy fatigability, headache, and fever. Case 4: A 60-year-old patient who presented with an eosinophilic liver abscess after prolonged antibiotic treatment failure.  \n WJCC  [https://www.wjgnet.com](https://www.wjgnet.com) 1 December 26, 2025  Volume 13  Issue 36   \nMulate ST et al. Hepatic fascioliasis: A neglected yet tricky disease  \nCONCLUSION  \nHepatic fascioliasis is frequently misdiagnosed due to its non-specific symptoms and limited diagnostic tools, especially in resource-limited settings. It is crucial to enhance awareness among healthcare professionals regarding its recognition and appropriate management. This case report aims to contribute to the growing body of literature on F. hepatica infection to facilitate timely diagnosis and empiric treatment with triclabendazole or nitazoxanide, as these are effective and reduce unnecessary intervention","cbCaijoGqS4rlIjF","https://ap.wps.com/l/cbCaijoGqS4rlIjF","pdf",10249787,11,"English","# Background\n# Case Summary\n# Conclusion\n# Core Tip\n# Key Words\n# Citation","[{\"question\":\"Why is hepatic fascioliasis difficult to diagnose?\",\"answer\":\"It is frequently misdiagnosed because symptoms are non-specific and diagnostic tools are limited, especially in resource-limited settings. Variable presentations can mimic other conditions such as malignancy or bacterial abscess.\"},{\"question\":\"What varied presentations are described in the four cases?\",\"answer\":\"Case presentations included suspected liver malignancy, urticaria with eosinophilia initially thought to be vasculitis, dyspeptic symptoms with systemic complaints, and eosinophilic liver abscess after prolonged antibiotic treatment failure.\"},{\"question\":\"What approach helps achieve timely diagnosis and treatment?\",\"answer\":\"A high index of clinical suspicion, careful history of exposure and travel, recognition of characteristic imaging, and correlation with eosinophilia are emphasized. Early empiric treatment with triclabendazole or nitazoxanide is noted as effective and can reduce unnecessary interventions.\"}]","Hepatic fascioliasis of emphasizing diagnostic difficulty and the need for high index of suspicion: Four case reports | PDF",1790568185,28]