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.
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.