Abstract
BACKGROUND: Fascioliasis is a parasitic zoonosis endemic to South America, caused by Fasciola hepatica. During the acute migratory phase, the parasite affects the liver parenchyma, potentially leading to complications such as abscesses or necrosis. However, spontaneous rupture of a hepatic subcapsular hematoma related to Fasciola hepatica infection is exceptionally rare and poorly documented in the literature. The aim of the present study is to report an unusual presentation of Fasciola hepatica infection and to highlight the diagnostic relevance of parasitic etiologies in patients with eosinophilia and atypical hepatic imaging findings in endemic areas or in patients with travel history. CASE PRESENTATION: A 38-year-old man from a rural area endemic for Fasciola hepatica presented with progressive right upper quadrant abdominal pain, dizziness, and fatigue. Physical examination revealed pallor and localized tenderness. Laboratory studies showed severe normocytic anemia (hemoglobin: 6.8 g/dL) and marked eosinophilia (2600 cells/μL). Abdominal CT revealed a large subcapsular hepatic hematoma with hemoperitoneum. Given the eosinophilia and epidemiological background, a parasitic cause was suspected. Western blot serology confirmed Fasciola hepatica infection. Liver function tests were normal, and there was no history of trauma or coagulopathy. The patient received conservative management, including fluid resuscitation, blood transfusion, and antiparasitic treatment with triclabendazole (10 mg/kg, repeated after 12 h). Follow-up imaging demonstrated gradual hematoma resolution. He was discharged after 10 days in stable condition and remained asymptomatic during outpatient follow-up. CONCLUSION: This case underscores the need to consider parasitic infections in the differential diagnosis of unexplained hepatic lesions with eosinophilia, especially in endemic areas. Early recognition enables effective non-surgical management.