Repeated Percutaneous Treatment of Massive Hepatic Cystic Echinococcosis in a Child

Abstract

Because of mostly asymptomatic cyst growth and often-neglected nonspecific low-grade symptoms, many cases of cystic echinococcosis (CE) caused by Echinococcus granulosus in the pediatric population are diagnosed at school age, in an advanced and even complicated stage. In 2003, after 5 months of intermittent dull upper-right abdominal pain and nausea, a 13-year-old boy was diagnosed with massive liver CE, with ∼20 round-shaped double-walled medium-sized infective cysts, which permeated the whole liver. Because of their wide distribution across the liver tissue and the risky superficial position of some cysts, liver transplantation emerged as the optimal therapeutic option. Despite being described as only an exceptionally used method for CE, we subjected our patient on 4 occasions to a radiofrequency energy thermoablation (RFT) procedure similar to the one used for malignant neoplasms. In total, 9 superficially situated cysts were initially treated with RFT by using a 14-gauge outer needle and a temperature of 70°C for 8 minutes per cyst, and the remaining cysts were treated with the puncture-aspiration-instillation-reaspiration procedure, along with albendazole (15 mg/kg per day) therapy, for a period of 20 months. After 2 years of follow-up, 4 residual small-sized semisolidified cysts were seen in the liver, and the patient showed no signs of relapse. Although not routinely used, RFT, along with puncture-aspiration-instillation-reaspiration and prolonged albendazole therapy, has shown good tolerability and long-term efficacy in the treatment of multiple infective CE, which could suggest the usefulness of the RFT method beyond salvage situations in pediatric patients.

Pediatric Echinococcosis of the Liver in Austria: Clinical and Therapeutical Considerations

“…This form of treatment is used when there are multiple cysts. The remaining cyst residues (scolices) can then be destroyed using the PAIR procedure [ 47 ]. However, we have no experience with this procedure due to the lack of suitable patients.…”

Echinococcus multilocularis drives the polarization of macrophages by regulating the RhoA-MAPK signaling pathway and thus affects liver fibrosis

“…Alveolar echinococcosis mainly originates from the liver. The molecular mechanism of Echinococcus multilocularis in inducing the damage of host liver cells in the early and mid-stage of infection has not been clearly elucidated [ 3 ], and no effective drugs that can reverse Echinococcus multilocularis -induced liver fibrosis have been developed [ 4 ]. Therefore, the molecular mechanism underlying liver fibrosis following alveolar echinococcosis infection and potential targets should be determined to improve the efficacy of anti-inflammation and anti-fibrosis treatment.…”

Cystic echinococcosis in a Moroccan boy: a silent and neglected disease among refugee and migrant children

“…CE is generally acquired during childhood and has an incubation period that can last for many years 5 6. The slow growth of the cyst, mostly asymptomatic or accompanied by minor non-specific symptoms, means that it is usually diagnosed in adulthood, and its diagnosis in children is relatively uncommon.…”

“…The slow growth of the cyst, mostly asymptomatic or accompanied by minor non-specific symptoms, means that it is usually diagnosed in adulthood, and its diagnosis in children is relatively uncommon. Most diagnoses are made at an advanced stage of the disease 6. The clinical presentation depends on the site and size of the lesion and ranges from an absence of symptoms to life-threatening conditions 7…”