Hepatic Fascioliasis Mimicking Hydatid Cyst and Complicated by Portal Vein Thrombosis: A Case Report From Ethiopia

Fascioliasis is a zoonotic helminthic infection often underdiagnosed in humans, particularly in endemic regions like Ethiopia. In its hepatic migratory phase, it can mimic other liver pathologies such as hydatid cysts or pyogenic liver abscesses, making diagnosis difficult. We report a case of a 48-year-old Ethiopian woman with a three-month history of right upper quadrant abdominal pain, intermittent fever, and vomiting. She frequently consumed raw lettuce and tomatoes. Laboratory evaluation revealed leukocytosis with marked eosinophilia. Abdominal ultrasound showed a heterogeneous hepatic lesion, raising suspicion for hydatid cyst or early liver abscess. Triphasic CT revealed multiple confluent hypoattenuating lesions in segment VII and thrombosis of the right anterior portal vein. Although serologic, parasitologic, and histopathologic confirmation was unavailable, the diagnosis of hepatic fascioliasis was strongly supported by clinical findings, radiologic features, endemic exposure, and rapid response to triclabendazole. Anti-parasitic therapy and anticoagulation resulted in clinical and hematologic improvement. This case highlights the diagnostic challenges of hepatic fascioliasis in low-resource settings and the importance of considering it in patients with hepatic lesions, eosinophilia, and portal vein thrombosis. To our knowledge, this is the first reported Ethiopian case of hepatic fascioliasis complicated by portal venous thrombosis.