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.
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.