Hepatic alveolar echinococcosis

Olivier Detry, Nicolas Meurisse, Jean Delwaide, Jean-Baptiste Giot, Philippe Leonard, Bertrand Losson, Marie-Pierre Hayette, Noella Bletard, Paul Meunier, Pierre Honoré
2018 Acta Chirurgica Belgica  
A 79-year old female patient with past history of breast adenocarcinoma underwent an abdominal computed tomography (CT) for asthenia and nausea. This CT demonstrated three separate hepatic lesions that were in large part necrotic, with peripheral calcifications and slow heterogeneous contrast uptake (Figure 1 ). Diagnosis of hepatic alveolar echinococcosis (AE) was made based on CT imaging and positive serology for Echinococcocus multilocaris. The patient was treated with albendazole 800 mg per
more » ... day for two months before undergoing hepatic surgery allowing radical resection of all lesions. Macroscopically, the resected tissue showed white masses ( Figure 2 ) with irregular multilocular, necrotic and cystic cavities ( Figure 3 ). Pathology confirmed the diagnosis of AE. The patient refused postoperative treatment with albendazole due to side effects. She was well one year later, without evidence of AE recurrence, and a progressive decrease of anti-echinococcosis antibody levels. AE is a severe parasitic zoonosis caused by E. Multilocularis cestode worms. AE is described in the northern hemisphere, and local cases have been described in Wallonia [1, 2] where up to 50% of the red foxes are infected [3] and where dogs might also be infected [4] . More than 15 local cases were treated at the CHU Liege these last 15 years. Association of radical surgery and albendazole (10 mg/kg in two daily doses) for two years is recommended in operable patients, and life-long albendazole is necessary in patients in whom radical surgical resection of all parasitic lesions is not Figure 1. Computed tomography of the liver demonstrating the biggest lesion of alveolar echinococcosis invading the segments II and III. Figure 2. Operative picture demonstrating the alveolar echinococcosis as a white lesion at the surface of segment III.
doi:10.1080/00015458.2018.1427838 pmid:29653501 fatcat:icx5di6abfgvzntdzkttknq3hi