The uninvited guest: live fasciola hepatica as a cause of obstructive jaundice—a case report

BACKGROUND: Hepatic fascioliasis is a zoonotic infection caused by Fasciola hepatica. It is underdiagnosed due to its non-specific clinical presentation and limited diagnostic tools in many healthcare settings. Human infections, though uncommon, are rising in endemic areas. CASE PRESENTATION: We report a 40-year-old South Asian female presenting with a 3-month history of vague right hypochondrial pain, nausea, and poor appetite. Laboratory tests showed cholestatic jaundice. Abdominal ultrasound revealed gallbladder sludge and a dilated common bile duct. ERCP was performed and revealed live Fasciola hepatica worms in the biliary tree. Post-extraction, she was treated with albendazole with complete resolution of symptoms and normalization of liver biochemistry. CONCLUSIONS: This case highlights the importance of considering hepatic fascioliasis in patients with atypical hepatobiliary symptoms, especially in endemic regions. ERCP played a pivotal role in both diagnosis and management.