Answer to Case 409

Answer: Fasciolopsis buski, the intestinal fluke

Although this is an older case (Case of the Week 227), I thought it was worth showing it again for the newer readers who may not have seen it. This is a parasite that we don't often see in the United States, but is common in Asia where freshwater plants are ingested.

The first step in making the diagnosis is recognizing that these objects are flukes - flat 'leaf-like' worms with an oral and ventral sucker:

The size of the fluke is also important. As you can see from the video, these flukes are quite large (!), measuring up to 7.5 cm in length. Intestinal obstruction and malabsorption commonly occur with heavy infections, as well as diarrhea, fever, abdominal pain and edema. The eggs are also important for making the diagnosis. In this case, thin-walled operculate eggs support our morphologic diagnosis.

Thank you to everyone who wrote in on this case!