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 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.