(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect patient privacy) Abstract: A 42-year-old female patient recently felt weak and lost her appetite, and gradually found that her eyes and face began to turn yellow, and once she went to the hospital to check her liver function, she found that her bilirubin level was elevated and liver damage was discovered, which was finally determined to be due to liver fluke caused by eating raw fish. Liver fluke is a parasite that lives in the human biliary system. The worm can cause blockage of the patient’s bile duct and liver damage. The parasite is removed by anti-parasitic drugs, liver-protective drugs, and by not eating raw fish, and the condition improves after 7 days of treatment. Basic information】Female, 42 years old 【Disease type】Hepatic schistosomiasis 【Visiting hospital】The Second Hospital of Harbin Medical University 【Visiting time】May 2022 【Treatment plan】Medication (antiparasitic drug praziquantel + liver-protective drug atomoxolam, glycolic) + life diet modification (no raw fish) 【Treatment cycle】Medication for 7 days, outpatient follow-up every six months 【Treatment effect】Review after 7 days Today, a middle-aged female patient came to the clinic. As soon as she entered the clinic, I could see that she had a yellowish complexion. I then began to ask her about her various medical histories related to liver injury. Through asking the medical history, I found that the patient had been unwell for more than 10 days. At first, she just had some weakness and poor appetite, but gradually her family noticed that her face and eyes started to turn yellow, and liver damage was found during the consultation at the local hospital, indicating that it might be caused by alcohol consumption, and her symptoms still did not get better after 4-5 days of IV liver-protective drugs, so she came to see the doctor. In the process of detailed medical history, we learned that although the patient had been drinking alcohol, but recently did not drink a lot of alcohol, the past years are also drinking beer mostly, the amount of alcohol is not very large, the previous also did not long-term, a lot of use of special drugs, under questioning, the patient complained of the habit of eating raw fish every year in the past, the river salvaged uncooked fish, sliced directly after the onion and ginger mixed with food, at this time the initial judgment for liver schistosomiasis. Subsequently, the relevant examination indicated an increase of eosinophils in blood routine, and liver ultrasound showed mild enlargement of liver, mild dilatation of bile ducts, hairy bile duct walls, and fecal liver fluke eggs (+), which was diagnosed as liver fluke disease in combination with clinical symptoms. Considering that schistosomiasis has a special transmission pathway and can be repeatedly infected, we asked the patient about her dietary habits, educated her about prevention of liver flukes, and asked her family to do a checkup. First, the patient was told to eliminate the habit of eating raw fish and, because of the patient’s current liver damage and obvious digestive symptoms, a light and soft diet, absolute abstinence from alcohol, and more foods rich in high-quality protein and vitamins were recommended in her lifestyle. Next, anti-parasitic treatment should be administered, and the patient should be treated with praziquantel. Finally, liver-protective treatment should be administered to reduce liver damage. Generally, commonly used liver-protective drugs such as Alto Moran and Glycolic can be used. While anti-parasitic, liver function and liver ultrasound should be closely monitored, and liver function can be stabilized only after the infection is gradually cleared. III. Treatment effect Patients’ liver function will still fluctuate in the early stage of anti-parasitic treatment. However, after using liver-protective drugs for about 1 week, they feel that their symptoms are significantly reduced and their appetite and energy are improved. The initial anti-parasitic drug, praziquantel, was selected for 5 days, followed by continued monitoring of blood and liver function as well as fecal parasite egg microscopy, which was negative for fecal eggs for 3 times in 1 week, suggesting that the patient had a good treatment effect. Since the patient’s liver function bilirubin level was still in the critical range and a little higher, it was recommended to continue oral liver-protective drugs for 1-2 weeks after discharge and monitor liver function and blood picture. Subsequently, liver function and liver ultrasound should be reviewed every six months to avoid repeated infections or recurrence. IV. Precautions We are glad that the patient’s symptoms have been reduced and effectively improved after treatment. Early liver fluke infection can be treated by anti-parasitic and liver preservation, but if the infection is long and has caused irreversible damage to the liver as well as the biliary tract, it is necessary to follow up with regular review, liver preservation treatment or extended anti-parasitic course. After discharge from the hospital, it is also necessary to change the diet, avoid eating raw fish, pay attention to kitchen hygiene, and separate raw and cooked food from cutting boards. After discharge from the hospital, it is necessary to monitor blood eosinophils, liver function, fecal parasite eggs and liver ultrasound, and to seek medical examination if symptoms appear again. V. Personal insight 1. Hepatobiasis is a parasitic disease obtained by eating raw fish. It is highly prevalent in some highly endemic areas such as riverine areas. Eating raw fish for a long time or vegetables that are not fully cooked after contamination by eggs on the cutting board can lead to liver fluke disease. You need to pay attention to deep-sea fish, such as salmon does not transmit liver fluke, but the market “fake salmon”, and salmon also need to beware; 2, liver fluke clinical manifestations are diverse, complex, with a certain degree of insidiousness. Many patients are not found until after the appearance of more serious obstructive jaundice. When unexplained liver injury and jaundice are found clinically, patients should be asked in detail about the epidemiology and dietary habits of the area in which they live, and be alert to the occurrence of liver flukes. If the patient is diagnosed with hepatic schistosomiasis, symptomatic treatment should be carried out and the recurrence of the disease should be strictly prevented; 3. The use of antiparasitic drugs for hepatic schistosomiasis is generally effective in treatment. However, if the infection is prolonged, the worm infarction is more serious or combined with serious bacterial infection, it may lead to severe infection bacteraemia and requires comprehensive treatment with surgical stent drainage.