Hydatidosis of infratemporal fossa with proptosis – an unusual presentation: a case report and review of the literature

Abstract

BackgroundHydatid disease is one of the common zoonotic diseases caused by the larval stage of Echinococcus granulosus. It is endemic in sheep-raising and cattle-raising areas worldwide and humans are an accidental intermediate host following the ingestion of the larvae. Head and neck involvement of echinococcosis is a rare entity and involvement of the infratemporal region is extremely rare even in endemic areas. Only a few cases of hydatid cysts located in the infratemporal fossa have been reported in the literature. Moreover, extension of the hydatid cyst into the intraorbital region and infiltrating into the surrounding orbital bone is even rarer.Case presentationWe present a case of a 65-year-old Gurung Nepalese woman with painless proptosis of her left eyeball of 2 months’ duration with recent progressive diminution of vision for 15 days. Radiological findings showed a cystic mass in the left infratemporal fossa extending into the left orbit and involving the surrounding orbital bone. Surgical removal was carried out. On histopathological evaluation, it was reported as hydatid cyst infiltrating into the bone. She was prescribed albendazole and discharged after surgery. However, she was lost to follow up and returned after 15 months with recurrence and proptosis of the same eye. Repeat excision of the lesion was carried out and postoperatively she was administered tablet albendazole. She was found to be disease free after 6 months of follow up.ConclusionsClinical and radiological findings are important but may not be sufficient in the preoperative diagnosis of hydatid disease especially if rare sites are involved. Proptosis may be seen in several conditions and orbital or infratemporal hydatidosis, although rare, should be considered a differential diagnosis.

Giant Cerebral Hydatid Cyst: A Rare Case Report

“…Surgery area of brain covering cotton soaked with warm normal saline to prevent spillage in case of rupture. Then, the cyst removes and dura closing watertight, bone flap puts back and patient dresses after wound closure 2,14 . After craniotomy and prior to the incision, the surgical field must be cleaned with scolicidal solution to prevent recurrence because even a minimal spillage can lead to new cysts formation (1 mL of cyst fluid contains 4 000 000 scolices) 15,16 …”

“…Then, the cyst removes and dura closing watertight, bone flap puts back and patient dresses after wound closure. 2,14 After craniotomy and prior to the incision, the surgical field must be cleaned with scolicidal solution to prevent recurrence because even a minimal spillage can lead to new cysts formation (1 mL of cyst fluid contains 4 000 000 scolices). 15,16 Albendazole has been used successfully for treatment of hydatid cyst in brain, 17 for prevention of secondary hydatid disease.…”

“…Dogs are definite hosts for the parasite and pass eggs with their faces. Humans are accidentally infected through ingestion of food or water contaminated with dog faces or by direct contact with dogs 1,2 . The disease is common in the Mediterranean countries, the Middle East, Australia, and New Zealand 3 .…”

Uncommon Locations of Cystic Echinococcosis: A Report of 46 Cases from Southern Iran

“…Bone hydatid cyst, which mostly affects the spine, accounts for 0.5% to 2.5% of hydatid cyst cases [ 10 , 11 , 28 , 29 ]. The bone hydatid cyst has been reported in 44 patients for 20 years in Iran [ 18 ].…”

“…Other tissues that are rarely affected by hydatid cysts include the perianal area, infratemporal region, or neck [ 10 , 12 – 14 ]. It has been shown that the replacement of hydatid cysts in unusual locations might be linked to the parasite genotypes and probably its intragenotypic features [ 15 ].…”