Alveolar echinococcosis – a neglected diagnosis of liver lesions

Česká verze

Authors: A. Kapľavka
Authors place of work: Gastroenterologická poradna, Nemocnice AGEL Nový Jičín a. s.
Published in the journal: Gastroent Hepatol 2025; 79(2): 127-129
Category: Hepatologie
doi: https://doi.org/10.48095/ccgh2025127

Summary

Alveolar echinococcosis (AE) is a rare but serious parasitic liver disease that often mimics malignant lesions. We present the case of a 76-year-old patient in whom AE was incidentally diagnosed during examination for renal insufficiency. Abdominal ultrasound revealed multiple hyperechogenic liver lesions. Subsequent MRI showed multiple irregularly bordered lesions without typical vascularization, the largest measuring 71 × 38 mm. Laboratory tests revealed elevated liver enzymes, CRP, and renal insufficiency. A core-cut liver biopsy confirmed the presence of pseudocystic structures. Samples were sent to the National Reference Laboratory for Tissue Helminthiases, which confirmed the diagnosis of AE. Serological testing was performed after the biopsy confirming the presence of antibodies against Echinococcus multilocularis. The patient was referred to an infectious disease clinic, where treatment with albendazole at a dose of 800 mg daily was initiated. After rehydration and adjustment of therapy, renal function stabilized, and follow-up imaging showed stable findings. This case highlights the need to include AE in the differential diagnosis of hepatic lesions, particularly in patients without an oncological history.

Keywords:

echinococcosis – liver – diagnosis – histology – biopsy – imaging methods – albendazole

Zdroje

1. Chalupa P, Strnad P, Leníček M et al. Alveolární echinokokóza –⁠ vzácné onemocnění vyžadující multidisciplinární přístup. Gastroent Hepatol 2018; 72 (4): 287–292. doi: 10.14735/amg2018287.

2. Hikaník M. Echinokokóza –⁠ onemocnění imitující generalizovaný nádorový proces. Vnitr Lek 2024; 70 (3): 195–197. doi: 10.36290/vnl. 2024.038.

3. Kern P, Menezes da Silva A, Akhan O et al. The echinococcoses: diagnosis, clinical management and burden of disease. Adv Parasitol 2017; 96 : 259–369. doi: 10.1016/bs.apar.2016.09.006.

4. Brunetti E, Kern P, Vuitton DA. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop 2010; 114 (1): 1–16. doi: 10.1016/j.acta tropica.2009.11.001.

5. Vuitton DA, Demonmerot F, Knapp J et al. Clinical epidemiology of human alveolar echinococcosis in Europe. Vet Parasitol 2015; 213 (3–4): 110–120. doi: 10.1016/j.vetpar.2015.07.036.

6. Wen H, Vuitton L, Tuxun T et al. Echinococcosis: advances in the 21st century. Clin Microbiol Rev 2019; 32 (2): e00075-18. doi: 10.1128/CMR. 00075-18.

7. Bresson-Hadni S, Koch S, Miguet JP et al. Indications and results of liver transplantation for alveolar echinococcosis. Liver Transpl Surg 1996; 2 (4): 250–260.

8. Deng X, Wang JJ, Wang ZX et al. Effectiveness and safety of ultrasound-guided percutaneous microwave ablation for hepatic alveolar echinococcosis. BMC Med Imaging 2022; 22 (1): 27. doi: 10.1186/s12880-022-00752-2.

9. Zhang T, Zhang Z, Zhang W et al. Comparison of local ablation with Albendazole or laparoscopic hepatectomy combined with Albendazole in the treatment of early hepatic alveolar echinococcosis. BMC Infect Dis 2022; 22 (1): 784. doi: 10.1186/s12879-022-07721-x.

10. Torgerson PR, Keller K, Magnotta M et al. The global burden of alveolar echinococcosis. PLoS Negl Trop Dis 2010; 4 (6): e722. doi: 10.1371/journal.pntd.0000722.