Dicrocoelium dentriticum in explanted liver, report of an unusual finding

Dicrocoelium dentriticum; a member of Trematode helminthes, is a liver parasite of ruminants. Humans are infected accidentally by ingestion of intermediate host; infected ants via eating of uncooked raw vegetables or drinking contaminated water. Infection is often asymptomatic or had subtle symptoms, so usually unrecognized. However it can produce chronic cholangitis and swelling or adenomatous proliferation in the bile ducts and lead to abdominal pain, diarrhea, fatigue, jaundice and etc.Spurious infection in endemic areas due to eating of contaminated animal liver is seen, even so frequent than true infection. For diagnosis of true Dicrocoelium infection, stool examination for finding of parasite’s ova after at least 3-day liver-free diet is necessary. We report a 49 year-old lady; known case of end stage hepatic cirrhosis due to viral hepatitis B + D co-infection. She has been complaining of pruritus in addition to hypoglycemic attack, abdominal pain and mild icterus. All symptoms refered to hepatic insufficiency. Also she had history of cholecystectomy several years ago. In a short time after transplantation , obstructive biliary signs such as direct bilirubinemia, moderate raise in serum aminotransferases and fever were appeared. Liver core needle biopsy was done 24-hour after transplantation for ruling out of rejection. In a same time explanted liver examined in path lab and show dilatation of hilar biliary ducts. Microscopic examination of liver core biopsy rule out rejection. Prepared sections of explanted liver revealed active cirrhosis associated with ductular proliferation . A helminth found in common bile duct. Morphologic reconstruction of helminth by microscopic findings and consultation with an expert parasitologist supported the diagnosis of Dicrocoelium dentriticum. The patient stool exam showed no any parasite’s ova . Praziquantel (40mg/kg three times a day) and Albendazole (400mg twice a day) were administered for the patient and dramatic clinical improvement appeared.

Keywords:

dicrocoelium , liver , transplantation