Introduction : WHO estimate, at least 2.4 million people are infected with Human Fascioliasis in more than 70 countries worldwide. Human becomes infected after consuming encysted larvae in aquatic plants or by drinking contaminated water. While fascioliasis is a well known disease in human , abnormal characteristic manifestation might be difficult to diagnosed the disease and mis-diagnosed for neoplasm

Methods : case report

Results : We present case of a male patient with history of intermittent fever for two months and epigastric pain for one month. CT scan revealed ill-defined hypodense lesion with few cystic component approximately at segment II of left lobe of liver also noted was complex solid cystic lesion at tail of pancreas with loss of fat plane between lesion and stomach, encasing the splenic hilum. FNAC of pancreatic cyst suggested intraductal papillary mucinous neoplasm. WBC 7,600/cumm, neutrophils 76%,lymphocytes 21% , eosinophils 1 %, serum amylase 377 IU/L, lipase 110 U/L,CEA 5.57ng/ml, CA19-9 11.3U/ml. Patient was treated for pancreatitis. Due to malignancy suspicion, underwent Radical Anterograde Modular Pancreatosplenectomy with left hepatectomy. Histopathology report multiple-cyst line by fibrinoid necrosis admixed with inflammatory cell in the spleen, pancreas and liver, report also noted a parasite, within cystic structure of spleen, and features of fascioliasis histomorphology.

Conclusions : While a handful of cases of human fascioliasis has been reported in Nepal, in nonendemic area, ectopic presentation is difficult to diagnosed and mistaken for neoplasm. Fascioliasis can be diagnosed by simple routine stool microscopy examination. Fascioliasis treatment is simple a short course of anti-helminthic therapy.