Delayed Diagnosis of Imported Cystic Echinococcosis and Successful Treatment With Percutaneous Drainage and Albendazole in Korea: A Case Report

Overview

Journal J Korean Med Sci

Date 2025 Feb 4

PMID 39901529

Authors

Won Jun Choi

Hanna Jin

Hyeon Jae Jo

Chan Mi Lee

Chang Kyung Kang

Pyoeng Gyun Choe

Wan Beom Park

Nam Joong Kim

Min-Ho Choi

Affiliations

Soon will be listed here.

Abstract

Echinococcosis, caused by the tapeworm , is rare in Korea and is primarily imported from endemic areas. We report a case of a 37-year-old Korean man with multiple large hepatic cysts, initially diagnosed as simple cysts at a local clinic in 2018. The patient had lived in Oman, an endemic area, for several months in 2016. Upon referral to a tertiary hospital in 2023, due to progressive cyst enlargement, liver magnetic resonance imaging revealed three large cysts with a water lily sign. Serum IgG against was positive by enzyme-linked immunosorbent assay. After diagnosis of echinococcosis, treatment with albendazole and puncture-aspiration-injection-reaspiration (PAIR) was performed. Microscopic and molecular analysis of cyst aspirates confirmed infection. Follow-up computed tomography demonstrated a reduction in cyst size, yet the emergence of a new right pleural effusion and consolidation in the left lower lobe of the lung necessitated the continuation of albendazole therapy. This case highlights the importance of thorough travel history, imaging findings, and the effectiveness of PAIR combined with albendazole in treating imported echinococcosis.

References

Byun S, Moon K, Suh K, Han J, Chai J . An imported case of echinococcosis of the liver in a Korean who traveled to western and central Europe. Korean J Parasitol. 2010; 48(2):161-5. PMC: 2892573. DOI: 10.3347/kjp.2010.48.2.161. View

Aregawi W, Levecke B, Ashenafi H, Byaruhanga C, Kebede N, Mulinge E . Epidemiology of Echinococcus granulosus sensu lato in the Greater Horn of Africa: A systematic review. PLoS Negl Trop Dis. 2024; 18(1):e0011894. PMC: 10810510. DOI: 10.1371/journal.pntd.0011894. View

Kang M, Lee S, Kim S, Chei Y, Park J, Park D . [A case of multiple intraperitoneal cysts from ruptured hepatic hydatid cysts]. Korean J Gastroenterol. 2007; 50(3):203-6. View

Kim S, Kim J, Han S, Kim Y, Cho J, Chai J . Recurrent hepatic alveolar echinococcosis: report of the first case in Korea with unproven infection route. Korean J Parasitol. 2012; 49(4):413-8. PMC: 3279681. DOI: 10.3347/kjp.2011.49.4.413. View

Higuita N, Brunetti E, McCloskey C . Cystic Echinococcosis. J Clin Microbiol. 2015; 54(3):518-23. PMC: 4767951. DOI: 10.1128/JCM.02420-15. View

Brunetti E, Kern P, Vuitton D . Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop. 2009; 114(1):1-16. DOI: 10.1016/j.actatropica.2009.11.001. View

Al-Kitani F, Mansoor M, Hussain M, Al Rawahi A, Saqib M, Al Maawali M . Sero-epidemiology of cystic echinococcosis (Echinococcus granulosus) in the livestock of Oman. Vet Parasitol Reg Stud Reports. 2019; 8:21-27. DOI: 10.1016/j.vprsr.2017.01.004. View

Stojkovic M, Mickan C, Weber T, Junghanss T . Pitfalls in diagnosis and treatment of alveolar echinococcosis: a sentinel case series. BMJ Open Gastroenterol. 2015; 2(1):e000036. PMC: 4599161. DOI: 10.1136/bmjgast-2015-000036. View

Ahn K, Hong S, Kang Y, Kwon J, Kim M, Park T . An imported case of cystic echinococcosis in the liver. Korean J Parasitol. 2012; 50(4):357-60. PMC: 3514430. DOI: 10.3347/kjp.2012.50.4.357. View

10.

Jin Y, Anvarov K, Khajibaev A, Hong S, Hong S . Serodiagnosis of echinococcosis by ELISA using cystic fluid from Uzbekistan sheep. Korean J Parasitol. 2013; 51(3):313-7. PMC: 3712105. DOI: 10.3347/kjp.2013.51.3.313. View

11.

Choi H, Park J, Kim J, Moon D, Lee J, Bae J . Primary renal hydatid cyst: mis-interpretation as a renal malignancy. Korean J Parasitol. 2014; 52(3):295-8. PMC: 4096642. DOI: 10.3347/kjp.2014.52.3.295. View

12.

Galeh T, Spotin A, Mahami-Oskouei M, Carmena D, Rahimi M, Barac A . The seroprevalence rate and population genetic structure of human cystic echinococcosis in the Middle East: A systematic review and meta-analysis. Int J Surg. 2018; 51:39-48. DOI: 10.1016/j.ijsu.2018.01.025. View

13.

Kang M, Kim K, Choi J . Hepatic cystic echinococcosis due to Echinococcus granulosus, grossly observed by needle aspiration. Korean J Intern Med. 2018; 34(6):1394-1395. PMC: 6823579. DOI: 10.3904/kjim.2018.155. View

14.

Shin D, Jo H, Kim J, Jun K, Beom Park W, Kim N . An Imported Case of Disseminated Echinococcosis in Korea. Korean J Parasitol. 2019; 57(4):429-434. PMC: 6753304. DOI: 10.3347/kjp.2019.57.4.429. View

15.

Riaguas Almenara A, Montesa Lou C . Anaphylactic shock secondary to ruptured hydatid cyst of liver into the pleural cavity. Radiologia. 2017; 59(5):460-461. DOI: 10.1016/j.rx.2017.04.001. View

16.

Deplazes P, Rinaldi L, Alvarez Rojas C, Torgerson P, Harandi M, Romig T . Global Distribution of Alveolar and Cystic Echinococcosis. Adv Parasitol. 2017; 95:315-493. DOI: 10.1016/bs.apar.2016.11.001. View

17.

Mattwich C, Huber K, Bretzel G, Suerbaum S, Wieser A, Dichtl K . Head-to-Head Comparison of Nine Assays for the Detection of Anti- Antibodies: A Retrospective Evaluation. Ann Lab Med. 2023; 44(2):155-163. PMC: 10628756. DOI: 10.3343/alm.2023.0212. View

18.

Saadi A, Amarir F, Filali H, Thys S, Rhalem A, Kirschvink N . The socio-economic burden of cystic echinococcosis in Morocco: A combination of estimation method. PLoS Negl Trop Dis. 2020; 14(7):e0008410. PMC: 7423152. DOI: 10.1371/journal.pntd.0008410. View

19.

Arif S, Shams-Ul-Bari , Wani N, Zargar S, Wani M, Tabassum R . Albendazole as an adjuvant to the standard surgical management of hydatid cyst liver. Int J Surg. 2008; 6(6):448-51. DOI: 10.1016/j.ijsu.2008.08.003. View

20.

Chai J, Seo M, Suh K, Lee S . An imported case of hepatic unilocular hydatid disease. Korean J Parasitol. 1995; 33(2):125-30. DOI: 10.3347/kjp.1995.33.2.125. View