Parasitic Gallbladder Infection: Case Study of Biliary Clonorchiasis in a Non-Endemic Region

BACKGROUND Clonorchis sinensis is a common liver fluke that typically inhabits the bile ducts, with infections primarily reported in endemic regions such as Northeast China, Korea, Taiwan, and Vietnam. Diagnosing parasitic infections of the biliary system can be challenging, particularly because their clinical presentation often overlaps with that of more common conditions such as acute or chronic cholecystitis. In regions where such parasites are not endemic, these infections are often overlooked, potentially leading to delayed or inappropriate treatment. Increased awareness is therefore essential. CASE REPORT We present a case of a 38-year-old woman from Irbid, Jordan, with no prior medical or surgical history, who presented with symptoms consistent with acute cholecystitis. Imaging showed a distended gallbladder with pericholecystic fluid, and laparoscopic cholecystectomy was performed. Histopathological examination revealed features of acute-on-top-of-chronic cholecystitis with a mixed inflammatory infiltrate including eosinophils. A fluke-shaped parasite, measuring approximately 2×1 millimeters in size and containing eggs, was morphologically consistent with Clonorchis sinensis. This finding was unexpected given the patient's lack of travel to endemic areas or known dietary exposure risks, such as consumption of raw freshwater fish. She was treated successfully with anti-helminthic medication and recovered completely without complications. Post-treatment follow-up confirmed full resolution without recurrence. CONCLUSIONS Although Clonorchis sinensis is not native to Jordan, this case highlights the importance of considering parasitic infections in the differential diagnosis of cholecystitis, even in atypical settings. As global travel and food importation increase, healthcare providers must remain vigilant for uncommon infectious etiologies presenting in non-endemic areas.