Human ectopic fascioliasis in Australia: first case reports.

OBJECTIVE: To describe the manifestations of two cases of migratory ectopic fascioliasis diagnosed in Australia, including the first report of lymphatic infection.
PRESENTATION: Both patients presented with acute, superficial swellings. In the first, a 46-year-old woman, the lump was found to be a cervical lymph node containing a mature Fasciola hepatica which had released eggs into surrounding tissues. The second patient was a 34-year-old male abattoir worker, in whom the subcutaneous lesion resembled an infected sebaceous cyst and contained an immature fluke.
FINDINGS: Both lesions were resected and diagnosed histologically. Fasciola eggs were not found in the faeces of either patient. Blood eosinophilia was not detected in either case. A serological test for fascioliasis was carried out in the second case and the result was positive. In both cases, infection was probably acquired in Australia, although neither patient had eaten watercress. OUTCOME: Neither patient was specifically treated with anthelminthic agents, and neither suffered further complications.
CONCLUSION: Migratory fascioliasis occurs in Australia. It can present as superficial or deep focal lesions, not necessarily in association with peripheral blood eosinophilia or Fasciola eggs in faeces. Serological tests may be helpful in diagnosing such cases.