A 6-Year-Old Boy with Facial Swelling and Monocular Blindness

Diagnosis: Ocular fascioliasis. The shape of the organism, including the cephalic cone, was consistent with Fasciola hepatica (figure 1). FAST-ELISA [1] demonstrated the presence of antibodies to excretory-secretory antigens, and Western blot demonstrated fasciola excretorysecretory antigens. It is likely that the complete paralysis of extraocular movements was the result of retro-orbital tension on nerves and muscles, attributable to inflammation and/or a possible postsurgical arteriovenous fistula. Over the ensuing months, the left cornea become calcified. Triclabendazole was administered at a dose of 10 mg per kg of body weight, and the patient experienced no adverse events. The liver fluke Fasciola hepatica is endemic in many temperate countries, and it primarily infects the biliary tract of sheep and other ruminants. Humans may be an accidental host, and ectopic disease may occur when immature flukes migrate to sites other than the biliary tree. Fascioliasis results from the ingestion of metacercaria encysted on aquatic vegetation, such as watercress. Following encystment in the duodenum, immature flukes usually migrate across the intestinal wall to the liver over a period of 5-6 weeks, with eggs appearing in the feces by ~4 months. This unusual case represents one possible manifestation of ectopic fascioliasis. Other ectopic sites include subcutaneous tissues, he CNS, lung, stomach, and cecum and epididymis. Morphologically, adult flukes are described as leaf-shaped, with a cephalic cone, and are approximately 1.5 x 3 cm in area. In this case, we considered infections with other large migrating helminths, such as Gnathostoma spinigerum, Paragonimus westermanii, and Spirometra mansoni, but the morphology and epid miology were most suggestive of fascioliasis, and this diagnosis was confirmed by the detection of F. hepatica-specific antibodies.