Clonorchis sinensis infection in an explanted liver in a patient with chronic hepatitis B infection and hepatocellular carcinoma

Background: Clonorchis sinensis infection is acquired through the ingestion of raw or undercooked freshwater fish, predominantly in endemic regions of East Asia. Chronic untreated clonorchiasis places the infected host at risk of hepatic steatosis, fibrosis, and eventually cholangiocarcinoma. Methods: We describe a 66-year-old patient who underwent liver transplantation for hepatocellular carcinoma who was found to have C. sinensis infection on the explanted histopathology. Results: There was no evidence of intrahepatic cholangiocarcinoma or other malignancy on the explanted liver. We provide a review of the literature, highlighting the epidemiology and long-term complications associated with clonorchiasis. Conclusions: Although C. sinensis is classically associated with cholangiocarcinoma, this case highlights the possibility that chronic clonorchiasis, particularly in association with other risk factors, such as hepatitis B, may contribute to hepatocarcinogenesis and development into hepatocellular carcinoma. Screening of at-risk populations for Clonorchis sinensis infection is important to ensure there are no long-term complications. Most importantly, with increasing global migration and culinary globalization, clonorchiasis is likely to be more commonly encountered in non-endemic countries. Our experience underscores that this infection is not a contraindication to transplantation.