A rare case of the simultaneous location of Echinococcus multilocularis in the liver and the head of the pancreas: case report analysis and review of literature

Abstract

Background Echinococcosis multilocularis (Hydatid Disease - HD) is a zoonotic disease caused by the larval form of Echinococcus multilocularis (EM). The main sites for this zoonosis are the Middle East, China, India, Alaska, and Siberia. It is rather rare in Europe. In Poland, the Warmian-Masurian Province is the endemic region for Echinococcus multilocularis. The clinical manifestation of the disease is dependent on the location, the size of the cyst and the development stage of the parasite. Considering the uncommon character of echinococcosis in Central Europe, especially such located in the areas outside the liver and lungs, the authors would like to present a case of coexistence in one patient of two EM foci in the liver and the head of the pancreas. Case presentation We present a clinical case of a 32-year-old man who was diagnosed with a cystic lesion with septa and calcification in the sixth segment of the liver and a suspicious change in the head of the pancreas. ELISA Em 2 plus test was positive, Western Blot method - the P-5 pattern showed an image that is characteristic of an EM infection. The sixth liver segment with a tumour and a tumour from the head of pancreas were excised by means of laparotomy. On the 6th day after the surgery the patient was discharged from hospital without complications and in good condition. Currently, he is under the control of a parasitic and zoonotic clinic. He takes an 800 mg daily dosage of Albendazole. Conclusions The presented clinical case shows that if we have a patient with cystic / tumour change in the pancreas and positive immunological tests, CT and MRI of the abdominal cavity are usually sufficient in order to fully diagnose and to qualify such a person for surgery. The most effective treatment is surgical treatment supplemented with pre- and postsurgical treatment with Albendazole.

Portal hypertension as a result of the incomplete surgically treated advanced alveolar echinococcosis: a case description

“…Moreover, in advanced alveococcosis only palliative operation can be performed to improve quality of the patient's life. Postsurgical frequency of recurrences is connected to incomplete parasite's excision [29]. Lately,in literature you can find descriptions of new surgical techniques such as associating liver partition and portal vein ligation, which can be safely in young individuals [30].…”

Improvement of Treatment and Prevention of Liver Echinococcosis

“…Difficulties in the diagnosis of pathology, especially in the initial stage, are created by a wide variety of symptoms of liver echinococcosis, which often depend on the location, size of the lesion and the stage of its development [13,14,15]. Echinococcosis of the liver is characterized by the presence of some local symptoms, in particular, moderate soreness with a dull character, thickening of the liver, patients' complaints of paroxysmal pain, sometimes simulating calculous cholecystitis, in the upper abdomen, in the epigastric region, sometimes there are signs of jaundice, shortness of breath.…”

Albendazole reduces hepatic inflammation and endoplasmic reticulum-stress in a mouse model of chronic Echinococcus multilocularis infection

“…Alveolar echinococcosis (AE) is a severe helminth disease caused by accidental ingestion of eggs from the fox tapeworm Echinococcus multilocularis [1,2]. After an incubation period of 5 up to 15 years without perceivable symptoms, AE has a fatal outcome in up to 90% of cases when left untreated [3][4][5]. AE is characterized by a slow but progressive tumor-like growth of metacestodes (larval stage) mainly in the liver, with a tendency to spread to various organs like spleen, brain, heart and other tissues such as bile ducts and blood vessels [6][7][8].…”