Case 2 was a 36 years old female with right upper quadrant abdominal pain, jaundice, severe joint pain, fatigue, 8 kg weight loss, and hypereosinophilia. Her stool tests and Fas-2 ELISA were positive for Fasciola. After failing a treatment course with triclabendazole (2 doses of 10 mg/kg every 12 hours), she was referred to our center. Over 10 months she received 1 additional course of triclabendazole treatment (2 doses of 10 mg/kg every 12 hours), a course of 3 doses of triclabendazole 10 mg/kg every 12 hours, and a course of 2 doses of triclabendazole 10 mg/kg every 12 hours followed by nitazoxanide (500 mg every 12 hours for 7 days) with marked improvement of symptoms but persistence of Fasciola eggs in the stools.
Case 5 was a 15 years old male who presented with epigastric pain, fever, shortness of breath, chest pain, 5 kg weight loss, hypereosinophilia, ascites, and pleural effusion. The stool tests for Fasciola were initially negative, but the Fas2 ELISA was positive. He was treated with a single dose of veterinary formulation triclabendazole with partial improvement of symptoms. His follow up stool tests were positive and remained positive since then despite 3 courses of triclabendazole (2 doses of 10 mg/kg every 12 hours each), and a course of 2 doses of triclabendazole 10 mg/kg every 12 hours in combination with nitaxozanide 500 mg every 12 hours for 7 days.