Fatal Alveolar Echinococcosis of the Lumbar Spine

Abstract

For the last 10 years, the southern part of Belgium has been recognized as a low-risk area of endemicity for alveolar echinococcosis. This infection, caused by Echinococcus multilocularis, usually induces a severe liver condition and can sometimes spread to other organs. However, alveolar echinococcosis involving bones has been described only very rarely. Here, a fatal case of spondylodiscitis due to E. multilocularis contracted in southern Belgium is reported. CASE REPORTA 75-year-old man, a former legionnaire living in the southern part of Belgium, was referred to our institution because of deterioration in his condition despite several treatment attempts. His medical history included alcoholic liver cirrhosis, diabetes mellitus type II, and the presence of numerous nonevolutionary lung nodules, thought to be aftereffects of tuberculosis.The patient initially came for a hospital consultation because he had been suffering from a severe pain in the lower back for a few weeks. Laboratory investigations revealed pathological values for hemoglobin (12.4 g/dl; normal values [NV], 13.3 to 17.2 g/dl), platelet count (102 ϫ 10 9 /liter; NV, 150 ϫ 10 9 /liter to 450 ϫ 10 9 /liter), C-reactive protein (40 mg/liter; NV, Յ6 mg/liter), alkaline phosphatase (137 IU/liter; NV, 40 to 124 IU/liter), gammaglutamyl transferase (66 IU/liter; NV, 5 to 50 IU/liter), gamma globulins (34%; NV, 11.1 to 18.8%), and total IgE (2,005 IU/ml; NV, 0 to 105 IU/ml). The patient's eosinophil count was within the normal range. A radiological examination confirmed the presence of an osteitis and a paravertebral abscess in the L5 region. A transbronchial biopsy of the pulmonary nodules was performed using a thin needle, and a histological examination revealed numerous necrotic granulomatous lesions, suggestive of tubercles. Thin-needle biopsies of the lumbar lesions also demonstrated the presence of several necrotic granulomas on histological examination. Bacteriological cultures including a specific medium for the growth of mycobacteria (MB/BacT system; bioMérieux, France) were performed on the pulmonary and lumbar biopsy specimens but proved negative, as did direct examination for acid-fast bacilli (AFB). A PCR specific for Mycobacterium tuberculosis (RealAccurate M. tuberculosis kit; Pathofinder, The Netherlands) was also performed on the lumbar biopsy specimens but was noninterpretable because of the presence of amplification inhibitors. In an attempt to confirm the suspected tuberculosis, chirurgical biopsies were performed on the L5 vertebrae and the paravertebral abscess. Histological examination again revealed the presence of granulomas, and all bacteriological cultures and microscopic examinations, including the detection of mycobacteria, remained negative. M. tuberculosis PCR performed on the biopsy specimens was negative (using the same method as used in the thin-needle biopsies).However, despite the lack of laboratory evidence, an antituberculosis treatment combining isoniazid, rifampin, ethambutol, pyrazinamide, and moxifloxacin was i...

Description of vertebral and liver alveolar echinococcosis cases in Cynomolgus monkeys (Macaca fascicularis)

“…Bone localizations were already described in our region in two patients, including one lethal [ 14 ]. That site for E. multilocularis larvae is exceptional, occurring in 1 % of all cases [ 15 , 16 ]. Previous cases of E. multilocularis infection in macaques described liver and abdominal cavity, kidney or lung lesions [ 1 ].…”

Skeletal manifestations of hydatid cystic disease in Sudan

“…Three cases were from Africa (Tunisia, Morocco, and the Mediterranean),7, 6, 5 three cases were from Europe,9, 10, 11 14 cases were from Asia12, 13, 14, 15 and one case was from Chile 16 . Two cases from the PubMed reports were of alveolar echinococcosis caused by E. multilocularis, which showed multiple bubbly cystic bone lesions 9, 10. One case report from Turkey identified this disease in the scaphoid bone, a small carpal bone in the hand.…”

Recurrent multiple-organ involvement of disseminated alveolar echinococcosis in 3 patients

“…The second patient had infection in spine, liver, lung, and gallbladder, whereas the third patient had AE involving spine, scapula, liver, and psoas major and rectus abdominis. AE of the spine [ 5 – 9 ] is rare; extraspinal bone AE is even rarer. [ 10 , 16 , 17 ] The first patient had the most unusual diagnosis, with AE being concurrently identified in thoracic vertebrae, left acetabular, and right scapula besides other organs.…”

“…[ 3 – 6 ] The involvement of bone in AE is extremely rare. [ 5 – 10 ] Here we report 3 cases of AE (Table 1 ) involving multiple organs, including bones, from Xinjiang Province of China where AE is endemic.…”