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 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.