PMC9132012_01
(A) The liver MRI image. There are several typical curved tunnel signs (red arrows and dotted frame) on T2WI. (B) A serial image of the patient before and after anti-helminthic therapy in the hepatic anterior lobe. The image on March 30th, 2021, showed typical "curved tunnel" signs in hepatic right anterior and posterior lobe on T1WI and T2WI image (red dotted frames and arrows). On April 17th, a month after the first therapy, the area of curved tunnel signs in hepatic anterior lobe decreased. After the following anti-helminthic treatments, the liver MRI image showed further decreased signs (29/7/2021). (C) A serial image showed dynastic change in the hepatic posterior lobe. On the image of March 30th, there were several curved tunnels in the marked yellow dotted frame. The new massive patchy slight hyperintense signals on April 17th were almost gone on the image of July 29th. Besides, we observed newly tunnel changes located under the subcapsular (orange arrows). (D) Coronal image showed subcapsular lesion appeared first on the image of May 18th, 2021. During the anti-helminthic therapy course, the lesion expanded and was progressed into abscess. (E) On the T1 contrast enhanced MR image, the subcapsular lesion in hepatic right lobe decreased significantly (red arrows).
fmed-09-881356-g0001.jpg
PMC9132012_01_fmed-09-881356-g0001.jpg
F1
Subsequently, liver MRI with routine T1- and T2-weighted images (axial and coronal panel) and diffusion-weighted images (DWI) was performed showing typical curved tunnel sign in right hepatic lobe (Figure 1A), consistent with the abnormal lesion on CDU image. On July 29, 2021, the MRI revealed that the above lesion had shrunk significantly (Figures 1B,C), suggesting that the hepatic injury possibly induced by T. spiralis might be improved after effective anthelmintic treatment. After intermittent treatment, on July 29, 2021, the lesion extended that had a similar appearance to the liver abscess (Figure 1D). The eosinophil count returned to normal 1 month after triclabendazole treatment (Figure 4), and the liver MRI showed that hepatic lesion was significantly regressed in anterior segment of the right hepatic lobe (Figure 1E), suggesting that the treatment was effective.
HE staining (400X) showed massive eosinophilic infiltration and abscess formation. The dashed white box indicates abscesses and the yellow arrow indicates eosinophilic infiltration.
fmed-09-881356-g0002.jpg
PMC9132012_01_fmed-09-881356-g0002.jpg
F2
The histopathological examination showed massive eosinophilic infiltration generating abscess or granuloma (Figure 2).
(A) The mNGS result. 1,299 specific Fasciola hepatica sequences that covered 0.0042% of the total Fasciola hepatica genome were detected by mNGS in the hepatic sample of the patient. The sequences were symmetrical matched with the median depth. (B,C)
Fasciola Hepatica and Trichinella spiralis identification of gene amplification.
fmed-09-881356-g0003.jpg
PMC9132012_01_fmed-09-881356-g0003.jpg
F3
Liver sample was also collected to identify the pathogen using metagenomic next generation sequencing (mNGS) technology, the number of species-specific reads aligning to the Fasciola hepatica (F. hepatica) genome in the liver biopsy was 1,299 (Supplementary Table 1, Figure 3A), which was further confirmed by polymerase chain reaction (PCR) (Supplementary Table 2, Figures 3B,C).
The dynamic changes of serological markers. (A-D) Eosinophil counts and percentages before and after every therapy (each therapy course: 3.18-3.24/4.15-4.20/5.14-5.22/6.14-6.23/8.30-9.6/9.15-9.20/10.1-10.5). The number of Eosinophil decreased after four therapies (June 23th). The count of Eosinophil showed a transient and significant increase on the measurement of July 29th, then kept within low level. (E) The trend of other markers. The level of IgE kept increasing and tripled compared with the first measurement. After four therapies, the level of IgE gradually went down. ALT, AST, albumin, and globulin kept within normal range.
fmed-09-881356-g0004.jpg
PMC9132012_01_fmed-09-881356-g0004.jpg
F4
The eosinophil count returned to normal 1 month after triclabendazole treatment (Figure 4), and the liver MRI showed that hepatic lesion was significantly regressed in anterior segment of the right hepatic lobe (Figure 1E), suggesting that the treatment was effective.