[Human infection with Dicrocoelium dendriticum].

UNLABELLED: MEDICAL HISTORY AND PHYSICAL EXAMINATION: A 36-year-old German reported having had chronic-relapsing diarrhea, right upper abdominal pain and weight-loss for about two years. His last journey had taken him to Morocco three and a half years ago. The physical examination was unremarkable except for an abdominal tenderness to palpation in the right upper quadrant. LABORATORY: The serum level of bilirubin was slightly raised to 1.13 mg/dl (<1.10 mg/dl) and the level of IgE was raised to 253 U/ml (<100 U/ml). All other laboratory findings were within normal limits. Stool examinations showed eggs of Dicrocoelium dendriticum. The abdominal ultrasound was unremarkable except for mild steatosis.

TREATMENT AND COURSE: The patient denied consumption of liver or liver-products within the past weeks. Spurious infection due to eating infected liver could thus be excluded. The patient was treated for dicrocoeliasis with praziquantel (3 x 600 mg/day for three days). Further stool examinations for parasites were negative. Since the patient still had gastrointestinal discomfort, we decided to give a further therapy with triclabendazole (700 mg, single dose). Five weeks after the second treatment the patient was almost free of symptoms and stool examinations for parasites remained negative.

CONCLUSION: Dicrocoeliasis can be associated with chronic diarrhea. Stool examinations for parasites are very important in patients with gastrointestinal symptoms.