Case Study 5 - Acute Cholangitis

September 8, 20082comments

A 62-year-old man reported having had fatigue, fever, and cramping abdominal pain for 7 days. He also reported that he had recently eaten raw pond smelt (Hypomesus olidus). The results of liver-function tests were abnormal, showing elevated levels of aspartate aminotransferase (350 IU per liter), alanine aminotransferase (352 IU per liter), alkaline phosphatase (204 IU per liter), gama-glutamyltransferase (434 IU per liter), total bilirubin (6.4 mg per deciliter [109 ┬Ámol per liter]), and conjugated bilirubin (3.9 mg per deciliter [67 ┬Ámol per liter]). The white-cell count was also elevated (13,000 per cubic millimeter), and there was eosinophilia (27%). A computed tomographic scan of the abdomen showed dilatation of the common bile duct without definite filling defects. Given our concern that the patient might have acute cholangitis, a duodenoscopy was performed, and a prominent major papilla was discovered. After cannulation of the common bile duct, numerous leaf-shaped worms popped out (click here or on image to see video).

Based on the above information, identify the worms and enter your answer in comments section.

Authors:

Do Hyun Park,
Hyun-Young Son
University of Ulsan College of Medicine
South Korea
Courtesy: New England Journal of Medicine
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+ comments + 2 comments

September 8, 2008 at 9:19 PM

its a liver fluke. May be Clonorchis sinensis or Fasciola hepatica.

September 18, 2008 at 5:19 PM

Hats off to Mullai, for the optimal diagnosis of this rare case.

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