Lytic parasitic: a case of bone destructing echinococcosis

Abstract

Pelvic hydatid bone disease is a rare and debilitating condition. Patients often present with symptoms and signs when the disease process is advanced and curative resection is not possible. We present a case of destructive bone hydatid disease affecting the left iliac bone. A 45-year-old woman presented initially 5 years ago with a left pelvic mass to the gynaecology department. Computed tomography (CT) scan done at that time showed a large pelvic, left iliac fossa cystic mass with the destruction of the left iliac bone. Extension of the cystic mass transversed the iliac bone into the posterior soft tissue. Percutaneous biopsy taken showed hydatid cystic disease. The patient was planned for surgery and, however, was lost to follow-up. Four years later, she presented with a history of worsening left pelvic pain with an enlarging, left pelvic mass, and another mass in the posterior gluteal area. In addition, CT imaging showed extensive left iliac bone destruction with posterior soft tissue extension to the gluteus muscle. A multidisciplinary team concluded that complete excision would not result in cure. Thus, complete iliac wing bone reconstruction was not an option in this patient. Instead, palliative measures were deemed in the patient’s best interest to control disease progression and relieve painful pressure-related symptoms from the hydatid cystic mass. The patient received preoperative albendazole and underwent an extraperitoneal debulking of the soft tissue hydatid infiltration and debridement of bony fragments from left iliac bone destruction. Postoperatively, the patient did well, and her main complaint of pain related to the cystic mass pressure had improved significantly.

Primary Renal Hydatid in Children

“…In extrahepatic disease, the sensitivity of these tests reduces to about 25-56%, limiting the use of serology to aid in the diagnosis. 12 The authors' patient had a weak positive titre of 26 on Echinococcus indirect haemagglutination serology testing. Renal hydatidosis often has characteristic appearances on imaging modalities.…”

Bone and Intramuscular Hydatid Cysts: A Rare Association

“…It most often shows poorly limited areolar lytic images, achieving the classic "honeycomb" appearance without periosteal reaction or surrounding soft parts calcifications [9]. In the pelvis, iliac bone involvement can have the characteristic "waffle-appearance", which pertains to a sizable area of osteolysis, as in our case [10]. However, this aspect is nonspecific and can be found in cases of bone tumors, tuberculosis or nonspecific infectious disease [11].…”

“…For muscular location, differential diagnosis includes abscesses, chronic hematomas, lymphangiomas, synovial cysts, and necrotic malignant soft tissue tumors [7,13]. Tuberculosis, chondrosarcoma, malignant fibrous histiocytoma, myeloma, metastatic disease, giant-cell tumor, aneurysmal bone cyst, plasmacytoma, a simple bone cyst, brown tumor of hyperparathyroidism, chondromyxoid fibroma are all differential diagnosis of bone hydatid cyst [10,14].…”

“…However, not all patients with echinococcosis are detected by serology. In extrahepatic disease, the sensitivity of these tests reduces to about 25-56%, limiting the use of serology tests to aid in the diagnosis of bone and muscular hydatid disease [10].…”

“…The prognosis of the disease depends on lesion volume and its location. Iliac bone involvement has a poor functional prognosis due to extension to the hip joint and more rarely to the sacrum [10]. Bone hydatid cyst has been called "white cancer" [15].…”