Case 4 is a 42 years old male born in the jungle of Cusco state married with case 3. He was admitted to the hospital with fever, diffuse abdominal pain, cough, severe fatigue, 5 kg weight loss, rash in the lower extremities and buttocks, and hypereosinophilia (eosinophil count > 30,000/dL). Lumbreras rapid sedimentation and Fas2 ELISA tests were positive for Fasciola hepatica infection. A few days after receiving triclabendazole treatment (2 doses of 10 mg/kg every 12 hours) his symptoms disappeared, but continue passing Fasciola ova. He was prescribed 2 additional treatment courses with triclabendazole (2 doses of 10 mg/kg every 12 hours) followed by a course of 2 doses of triclabendazole 10 mg/kg every 12 hours combined with nitaxozanide 500 mg every 12 hours for 7 days and 2 courses of triclabendazole veterinary formulation turning his Kato Katz tests negative. However, the Lumbreras rapid sedimentation test has remained positive.
Case 3 was a 43 years old female who was asymptomatic. She was tested for Fasciola hepatica ova after her husband (case 4) was diagnosed with the infection. Both Fas2 ELISA and stool tests were positive for Fasciola infection. She failed a course of triclabendazole (2 doses of 10 mg/kg every 12 hours) and was prescribed 2 doses of triclabendazole 10 mg/kg every 12 hours followed by nitaxozanide 500 mg every 12 hours for 7 days after which she developed intrahepatic bile obstruction with removal of 3 adult Fasciola by endoscopic retrograde cholangiopancreatography. Also a migratory subcutaneous nodule due to Fasciola developed despite self-medication with a veterinary formulation of triclabendazole in 2 occasions. She was prescribed triclabendazole (2 doses of 10 mg/kg every 12 hours) with negative stool tests for Fasciola at 5–6 weeks follow up.