Introduction
Chronic liver fluke disease is caused by Clonorchis sinensis, and is a familiar disease in the world. It can cause gall-stone, cholecystitis, cholangitis, obstruction of the bile duct, pancreatitis, urticaria, and even liver cancer and adenocarcinoma of the pan\|creas.[1-8] Clinically, this disease often causes hepatitis, angiocholecystitis, cirrhosis of the liver, which are of absence of symptoms. In this report, we describe a case of chronic liver fluke disease with a few symptoms of dyspepsia.[9,10]
Case report
A 46-year-old man was hospitalized because of anorexia, abdominal distention, bellyache and loose stools for many years. The patient recalled that his colleagues in army had infected liver fluke after eating fresh fish and shrimp when he was in military service in Guangdong Province 22 years ago. Physical examination revealed that his body temperature was 37.5 ℃, pulse was 88 times/min, and BP was 10.6 mmHg. The liver was mildly enlarged and hepatic region showed obvious tenderness. Laboratory results included WBC 24?109/L, trophilic granulocyte 0.65, lymphocyte 0.28, and eosinophil 0.07. HAV-IgM and HBsAg were all negative, GPT was 42.5 U/L, and total bilirubin was 14.3 μmol/L. Ultrasonography showed tumefied liver, dense and asymmetric smudge, slightly outstretched small bile ducts, thicker dissepiment, enhanced echo, outstretched bile ducts with spot, plaque and line echoes, thick and rough wall of cholecyst, and bar or plaque echoes. CT demonstrated that the bile ducts in the liver were outstretched slightly and diffuse, and that cholecyst and pancreatic ducts were normal. Filemot and sesamoid eggs were found by the inverted sedimentation method in the stool in three days. Microscopy showed that the anterior extremity of the egg had a small cap, the shell of egg beside the cap was protuberant slightly, the posterior extremity of the egg was obtuse, and the distal end had a verrucous protuberance. These characteristics were consistent with those of the egg of Clonorchis sinensis. The patient was diagnosed as having chronic liver fluke disease. The appetite of the patient recovered basically after three courses of treatment with praziquantel.[11,12] The patient had no obvious ill response in follow-up for two months.
Discussion
The symptoms of chronic liver fluke disease are complex. Clinically, chronic liver fluke disease can cause hepatitis, dyspepsia, angiocholecystitis, paraneurasthenia, cirrhosis of the liver and parananosoma, even no symptoms at all. Although the patient had the symptoms of emaciation, anorexia and abdominal discomfort, his HAV-IgM and HBsAg were all negative, cholecyst and pancreatic ducts were normal, and stool examination showed positive results. The disease was diagnosed as chronic liver fluke disease with dyspepsia. The appetite of the patient recovered basically after treatment of praziquantel. This disease supposed to be related to eating fresh fish and shrimp 22 years ago.
Competing interest
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References
1 Kim YH. Pancreatitis in association with Clonorchis sinensis infestation: CT evaluation. Am J Roentgenol 1999;172:1293-1296.
2 Shin HR, Lee CU, Park HJ, Seol SY, Chung JM, Choi HC, et al. Hepatitis B and C virus, Clonorchis sinensis for the risk of liver cancer: a case-control study in Pusan, Korea. Int J Epidemiol 1996;25:933-940.
3 Colquhoun BP, Visvanathan K. Adenocarcinoma of the pancreas associated with Clonorchis sinensis infection. Can Med Assoc J 1987;136:153-154.
4 Coskey RJ. Urticaria due to Clonorchis sinensis. Arch Dermatol 1977;113:1130-1131.
5 Ho JK, Lau WY, Liu K, Leung N, Leung T, Liew CT, et al. Liver infested with Clonorchis sinensis in orthotopic liver transplantation: a case report. Transplant Proc 1994;26:2269-2271.
6 Nakashima T, Sakamoto K, Okuda K. A minute hepatocellular carcinoma found in a liver with clonorchis sinensis infection: report of two cases. Cancer 1977;39:1306-1311.
7 Purtilo DT. Clonorchiasis and hepatic neoplasms. Trop Geogr Med 1976;28:21-27.
8 Juszczyk J. Pathogenesis of intrahepatic cholestasis. Pol Tyg Lek 1973;28:585-588.
9 Wang KX, Zhang RB, Cui YB, Tian Y, Cai R, Li CP. Clinical and epidemiological features of patients with clonorchiasis. World J Gastroenterol 2004;10:446-448.
10 Yu SH, Kawanaka M, Li XM, Xu LQ, Lan CG, Rui L. Epidemiological investigation on Clonorchis sinensis in human population in an area of South China. Jpn J Infect Dis 2003;56:168-171.
11 Tinga N, De NV, Vien HV, Chau L, Toan ND, Kagerand PA, et al. Little effect of praziquantel or artemisinin on clonorchiasis in northern Vietnam. A pilot study. Trop Med Int Health 1999;4:814-818.
12 Peters M, Frenzel H, Kade H. Therapy of infections with clonorchis sinensis. Med Klin 1973;68:1255-1261.
Received August 9, 2004
Accepted after revision October 10, 2004
