Clonorchiasis presenting with shock and jaundice: a case report

Abstract

Abstract Background Clonorchiasis is caused by infection with Clonorchis sinensis, a foodborne parasitic disease and one of the most common zoonoses. Currently, China remains the country with the highest number of Clonorchis sinensis infections in the world. Although the infection rate has decreased nationwide, some areas still exhibit a highly endemic trend. This article reports a case study of clonorchiasis manifested with shock and jaundice in a patient admitted to the intensive care unit (ICU). This case underscores the importance of increasing clinicians’ awareness and enhancing their management skills concerning atypical and severe presentations of clonorchiasis. Case presentation A forty-two-year-old male was admitted with “dark urine accompanied by yellow discoloration of skin and sclera for 1 week, and abdominal pain for two days”. The patient presented primarily with dark urine and jaundice, showed no improvement after anti-infective treatment at a local hospital, and rapidly progressed to shock. He was transferred to our department with diagnoses of “sepsis, septic shock, and jaundice of unknown origin”. Physical examination revealed generalized jaundice of skin and sclera, extensive subcutaneous ecchymoses on neck, chest and right upper arm, tenderness in left upper quadrant without rebound tenderness, and no other positive signs. Diagnosis and treatment Endoscopic retrograde cholangiopancreatography (ERCP) revealed live Clonorchis sinensis under direct visualization. Fluid resuscitation, vasopressors for shock management, bedside ERCP with nasobiliary drainage to remove clonorchis sinensis and relieve biliary obstruction. Following appropriate management, the patient recovered and was discharged from the hospital. Conclusion Detailed dietary history collection can effectively avoid misdiagnosis of Clonorchiasis. ERCP plays a crucial role in the diagnosis and therapy of this disease. Severe clonorchiasis cholangitis may manifest as shock, pain, jaundice, and asymptomatic fever. Aggressive resuscitation from shock and multi-organ support therapy can significantly improve patient prognosis.