Hepatic Fascioliasis Complicated by Multisite Venous Thromboembolism: A Rare Association and Implications for Parasite-Associated Coagulopathy

Hepatic fascioliasis is a trematode flatworm infection caused by Fasciola hepatica or Fasciola gigantica. Its association with venous thrombosis is exceedingly rare and can lead to significant morbidity when complicated by such conditions. Here, we report a rare case of hepatic fascioliasis complicated by multisite venous thromboembolism (VTE), highlighting the potential link between parasitic infections and coagulopathy. A 41-year-old woman presented with right leg swelling of 3 days duration. Examination revealed hypoxemia, tachypnea, and unilateral leg swelling. Laboratory tests showed marked eosinophilia, while imaging revealed multiple hypovascular focal hepatic lesions suggestive of Fasciola hepatica, alongside acute thrombosis of the right branch of the portal vein, iliac and femoral veins, and bilateral pulmonary emboli. Stool examinations were negative, but Fasciola hepatica IgG serology was elevated. The patient later developed right upper quadrant pain and a drop in hematocrit; repeat imaging showed sub-capsular and parenchymal hepatic hematomas, likely related to parasite-induced liver damage and anticoagulation. She was managed with antiparasitic therapy, anticoagulation, blood transfusion, and supportive care, with good recovery. This case underscores the need to consider fascioliasis in patients from endemic regions presenting with unexplained eosinophilia and venous thrombosis. It illustrates a rare but serious complication and highlights the importance of early diagnosis, integrated management, and further research into parasite-associated coagulopathy.