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.
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.