# Multisystem involvement in hydatid disease: a case report of disseminated echinococcosis

## TL;DR

This case report describes a rare instance of widespread hydatid disease affecting multiple body systems, emphasizing the importance of imaging for diagnosis and management.

## Contribution

The paper presents a rare case of disseminated echinococcosis with unusual spinal and soft tissue involvement.

## Key findings

- Multimodality imaging confirmed multiple hydatid cysts in the pelvis, retroperitoneum, spine, and other areas.
- The case highlights the diagnostic value of imaging features in disseminated hydatid disease.
- PAIR therapy was contraindicated due to the cysts' location, and surgery was declined.

## Abstract

Hydatid disease is a zoonosis caused by the larval stage of Echinococcus granulosus, most often affecting the liver and lungs. Disseminated hydatidosis is rare, accounting for <10% of cases.

We present a 28-year-old man with paraplegia and abdominal pain. He was first diagnosed with hydatid disease at a government hospital 3 years earlier and presented to us with only an ultrasound (US) report. No serology reports were furnished. He had deferred surgery due to financial constraints. At current presentation, US, computed tomography (CT), and magnetic resonance imaging (MRI) demonstrated multiple cysts across the pelvis, retroperitoneum, spine, mediastinum, neck, and extremities. Imaging morphology was consistent with the WHO-IWGE (Informal Working Group on Echinococcosis) CE1–CE3 hydatid cysts. Differentials including abscess, cysticercosis, necrotic metastases, and lymphangioma were ruled out based on the absence of contrast enhancement, calcification pattern, and clinical correlation.

Surgery was advised, but was declined. PAIR (puncture, aspiration, injection, re-aspiration) was contraindicated due to multivesicular bone and spinal cysts. The patient was managed with oral albendazole. Follow-up data are currently unavailable.

This case highlights disseminated hydatid disease with an unusual spinal and soft tissue involvement. Multimodality imaging is pivotal for diagnosis and treatment planning. Awareness of the imaging features is essential for timely recognition and management.