Subscapular hepatic hematoma and extensive venous thrombosis associated with suspected fascioliasis: a case report from Ethiopia

Fascioliasis, a zoonotic infection caused by Fasciola hepatica , is endemic in parts of Ethiopia. While hepatobiliary symptoms are common, vascular complications such as portal vein thrombosis (PVT) and deep vein thrombosis (DVT) are rarely reported. We describe a case of suspected fascioliasis presenting with a large hepatic subcapsular hematoma, PVT, and extensive DVT in a patient from a rural endemic area with a history of sheep farming. A 58-year-old woman from a rural highland area of Ethiopia, with a history of sheep farming and frequent consumption of inadequately cleaned raw vegetables, initially presented with progressive right lower limb swelling due to proximal deep vein thrombosis (DVT). One month later, despite therapeutic anticoagulation, she developed severe right upper quadrant abdominal pain and symptoms of anemia. Triphasic abdominal computed tomography (CT) revealed a large right hepatic subcapsular hematoma (approximately 732 mL), multifocal intraparenchymal lesions, portal vein thrombosis, and extension of thrombosis to the right external and common iliac veins. No serological testing for Fasciola hepatica was performed, and repeated stool examinations for eggs were negative. Persistent eosinophilia (peaking at 32.7%), combined with her occupational exposure to sheep and dietary history, raised strong clinical suspicion for fascioliasis despite repeatedly negative stool examinations. She was managed with blood transfusion, careful anticoagulation, and empiric triclabendazole therapy (400 mg daily for two days). Her symptoms, eosinophilia, hematoma, and thrombi showed gradual resolution on follow-up imaging at six months. Fascioliasis should be considered in patients from endemic areas who present with unexplained eosinophilia, hepatic abnormalities, and thrombotic events, even when parasitological tests are negative and serological confirmation is unavailable. A history of sheep farming or raw vegetable consumption provides important diagnostic clues. Prompt recognition and empiric antiparasitic treatment, along with supportive care, can lead to favorable outcomes.