A case of human fascioliasis with hypereosinophilia and migrating liver abscess

【症 例】54歳,女性.【現病歴】微熱･倦怠感を自覚し近医受診.好酸球増多を認め,精査目的で血液内科紹介となった.初診時微熱以外には,皮疹･リンパ節腫大等認めなかった.白血球11500/μl,好酸球59%と著明な好酸球増多,加えてLDH340U/ml,ALP500U/ml,γ-GTP61U/ml,CRP1.82mg/dlと胆道系酵素異常および炎症反応上昇を認めた.腹部CTでは膿瘍を疑う低吸収域を認めた.2週間後に右季肋部激痛を自覚,CTでの病変は右葉後区域から前下区域主体に移動した.寄生虫疾患の関与を疑い肝生検を施行,好酸球浸潤を伴う膿瘍所見を認め,血清学的に肝蛭症の診断に至った.トリクラベンダゾールでの治療を検討,国立国際医療研究センターと協議し薬剤を入手し治療を行い,好酸球増多および肝低吸収域の改善を確認した.【考 察】好酸球増多を契機に肝蛭症の診断を得て,WHO推奨治療を行った症例を経験した.好酸球増多の原因は多岐に渡るが,移動性肝臓異常陰影を伴えば肝蛭症の可能性が高いとされている.肝蛭症診断における便虫卵法は陰性のことが多く血清学的診断が主体とされるが,実施は未だに一般的ではなく,治療薬の保険未適用を含め今後の課題であると思われた.

We experienced a case of human fascioliasis. A 54-year-old female was refered to our hospital with low grade fever and remarkable hypereosinophilia. The laboratory findings included white blood cell 11500/μl with 59% eosinophils and elevated levels hepato-biliary enzyme. Two weeks later, computed tomography demonstrated migrating low-density areas and liver biopsy revealed eosinophilic abscess and granulation. The diagnosis was made by the serological test and eggs in the feces were negative. Treatment with triclabendazole resulted in disappearance of the abnormal liver radiographic findings, and a reduced blood eosinophilic level.This parasitic disease is a neglected infectious disease. We conclude it is necessary to keep in mind that hypereosinophilia and migrating liver abscess are suggestive of human fascioliasis.

肝蛭症　

好酸球増多症

肝膿瘍