A 52-year-old woman was admitted with a 3-month history of pain in the right upper quadrant of the abdomen and fever for the last 2 weeks. The patient was born and lives in the highlands of Peru and reported regularly consuming raw vegetables and drinking infusions made of alfalfa. There was no history of travel, and she denied any underlying medical condition. The physical examination at admission revealed a chronically ill patient in no distress; no rash, jaundice, or lymphadenopathy was observed. Findings of chest and cardiovascular examinations were unremarkable. Tender hepatomegaly was found. Laboratory examinations revealed a hematocrit of 40%; white blood cell count of 18,600 cells/mm3 with 62% eosinophils; normal total bilirubin level; and mild elevation of levels of aspartate amino transferase (AST) 124 IU/L (<40), alanine aminotransferase (ALT) 75 IU/L (<40), alkaline phosphatase 274 IU/L (20–140). A contrast computed tomographic (CT) scan of the abdomen was performed (Figure 1). The liver span was measured as 17.5 cm and contained a large subcapsular hypodense nonenhancing collection located in segments VI and VII, and multiple small cystic lesions scattered throughout the liver parenchyma. On the basis of the history and the abdominal CT scan findings, a stool examination for ova and parasites was requested (Figure 2)....