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 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.