Clinico-imaging approach to multivisceral echinococcosis – case report

Abstract

Background. Echinococcosis is an endemic zoonotic disease caused by the larval stage of Echinococcus granulosus. The liver and the lungs are the most frequently affected organs (56% and 25%). In our country, the disease shows a high prevalence, with an increasing incidence of multivisceral involvement. Objective(s). To present a clinical case of pulmonary hydatidosis with an atypical differential diagnosis and evolution, incidentally revealing multivisceral echinococcosis through imaging. Materials and methods. We analyzed the case of a patient with suspected acute pulmonary infection. Despite antibiotic treatment, the patient showed clinical worsening of the infectious syndrome and bronchial obstruction, and right-sided pleuritic chest pain. The patient underwent imaging evaluation by abdominal ultrasound and HRCT of the thorax and abdomen. Results. A 20-year-old student was admitted to the Pulmonology Department for management of pneumonia unresponsive to combined antibacterial therapy. He presented with a productive cough, worsened when lying down. Laboratory tests showed mild leukocytosis and absolute eosinophilia, also noted previously and attributed to an intestinal parasitosis. On liver palpation, a prominent mass was detected in an upright position, confirmed by ultrasound along with four other hepatic cysts under 6 cm. Thoraco-abdominal HRCT confirmed five hepatic hydatid cysts and one partially drained pulmonary cyst in the right S8 segment.The patient was referred to a surgeon. Conclusion(s). Pulmonary hydatidosis may present atypically, mimicking communityacquired pneumonia. Annual chest radiography, careful evaluation of unexplained peripheral eosinophilia, sputum analysis, and/or bronchoscopy can support early diagnosis of pulmonary echinococcosis and an appropriate treatment.