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Hepatobiliary Fluke — RACP Adult Medicine MCQ

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ModerateInfectious DiseasesHepatobiliary FlukeRACP Adult Medicine

A 40-year-old man returned from Southeast Asia 3 weeks ago presents with eosinophilia (3.5 × 10⁹/L), urticarial rash, and RUQ pain. LFTs show elevated ALP and GGT. Stool microscopy shows large operculated eggs. Ultrasound shows dilated intrahepatic bile ducts with a worm-like filling defect. What is the most likely cause of eosinophilia?

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Correct answer: A — Helminth infection (liver fluke)

Eosinophilia with RUQ pain, cholestatic LFTs, operculated eggs on stool microscopy, and biliary filling defects after travel to Southeast Asia is hepatobiliary fluke infection (Opisthorchis/Clonorchis). Tissue-invasive helminths are the commonest cause of marked eosinophilia worldwide. Treatment is praziquantel. Long-term infection increases cholangiocarcinoma risk.

Reference: eTG Antibiotic – 2025 – Helminths; WHO 2024