Spontaneous hepatic hemorrhage in fascioliasis: Imaging and diagnostic challenges in a rare case series from East Africa.

Fascioliasis is a zoonotic infection caused by the hepatic trematodes Fasciola hepatica and Fasciola gigantica. It presents with nonspecific symptoms, which can occasionally be complicated by rare but severe manifestations such as spontaneous hepatic hemorrhage. This study describes 3 cases of fascioliasis in female patients aged 35-56 years, who presented with right upper quadrant pain and nonspecific symptoms, including anorexia, nausea, and weakness. Laboratory investigations revealed hypereosinophilia and elevated liver enzymes. Imaging showed massive subcapsular and intrahepatic hematomas, along with multiple linear hypodense liver lesions. Given the lack of availability of immunological testing locally, empirical treatment with triclabendazole was initiated. The diagnosis in all cases was later confirmed through serological tests sent abroad. All patients showed significant clinical improvement with resolution of the eosinophilia and reduction of hepatic hemorrhage upon follow-up. These cases emphasize the importance of considering fascioliasis in patients presenting with hepatic hemorrhage and eosinophilia, and highlight the role of imaging and fine-needle aspiration cytology (FNAC) in guiding early empirical treatment when definitive serological testing is unavailable.