# An alluring case of an infected hepatic hydatid cyst: A case report

## TL;DR

A rare case of an infected liver hydatid cyst in a 48-year-old woman is reported, highlighting diagnostic and treatment challenges.

## Contribution

This case report presents a rare instance of an infected intact hepatic hydatid cyst diagnosed intraoperatively.

## Key findings

- Infection of an intact hydatid cyst is rare and often occurs in immunocompromised individuals.
- Diagnosis of infected cysts can be difficult with imaging alone and may require surgical confirmation.
- Surgical pericystectomy combined with targeted antibiotics improves outcomes in infected cases.

## Abstract

Hydatid cyst is a tapeworm infection that most commonly involves the liver and lungs. Other organs that have been found to be involved are the brain, heart, and bones. Humans are accidental, intermediate hosts and become infected after ingesting the eggs of the parasite. The rupture of the cyst can lead to infection which can subsequently lead to the development of an abscess causing complications like peritonitis.

Here we present a case of a 48-year-old female who was known case of hypertension and diabetes, on medication presented with complaints of an irreducible mass in the right hypochondriac region for 6 months associated with a dull aching type of pain for 3 days with associated fever. Imaging revealed the presence of an intact cyst that was suspected to be a hydatid cyst. The patient was taken up for a pericystectomy during which the cyst was found to be infected based on purulent contents and culture of the contents.

Hydatid cyst consists of an endocyst and a pericyst. Hence, infection of the cyst is a rare phenomenon and is seen in immunocompromised patients. The presence of an intact cyst seen both intraoperatively and on imaging makes this case a rare occurrence.

Infection of a hydatid cyst is a complication, difficult to diagnose on imaging. Early surgical intervention like incision and drainage of the abscess followed by pericystectomy should be performed, following which appropriate antimicrobial therapy should be started.

•Hydatid disease is a parasitic infection caused by Echinococcus granulosus and often affects the liver and lungs.•Infected cysts may present with fever and right upper abdominal pain despite intact walls on imaging.•Even with modern imaging, definitive diagnosis may only occur intraoperatively.•Surgical pericystectomy is preferred for large or complicated hydatid cysts.•Targeted antibiotics post-surgery improve outcomes in infected hydatid cysts.

Hydatid disease is a parasitic infection caused by Echinococcus granulosus and often affects the liver and lungs.

Infected cysts may present with fever and right upper abdominal pain despite intact walls on imaging.

Even with modern imaging, definitive diagnosis may only occur intraoperatively.

Surgical pericystectomy is preferred for large or complicated hydatid cysts.

Targeted antibiotics post-surgery improve outcomes in infected hydatid cysts.