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 1 was a 51 years old female farmer with 16 kg weight loss, right upper quadrant abdominal pain, night sweats, anorexia, malaise, fever, and hypereosinophilia. She was first treated with a single dose of 10 mg/kg triclabendazole with improvement of symptoms. However, after 8 months her symptoms returned and she was again noted to be shedding Fasciola eggs. The patient was treated 2 additional times with triclabendazole (each with 2 doses of 10 mg/kg every 12 hours) and then with 2 doses of triclabendazole 10 mg/kg every 12 hours followed by nitaxozanide 500 mg every 12 hours for 7 days with improvement of symptoms. However, continued to pass Fasciola eggs on stool tests.