HCA Healthcare/USF Morsani College of Medicine GME: Largo Medical Center Largo, FL, United States
Mohid Mirza, DO1, Janyll Castineira, DO2, Karthik Sugumaran, DO1, Hussein Osman-Mohamed, MD1, Miriam Thomas, MD1, Richard Munoz, MD1 1HCA Healthcare/USF Morsani College of Medicine GME: Largo Medical Center, Largo, FL; 2HCA USF Morsani Largo Medical Center, Largo, FL
Introduction: Cystic Echinococcus (CE), or hydatid disease, is a tapeworm infection mostly affecting developing nations and rural areas. While cases in the United States (US) are relatively rare, increased globalization and immigrant travel from endemic areas has transformed this entity into one that American clinicians should be familiar with. Proper diagnosis and staging of CE help determine the appropriate therapeutic approach. We present a case of chronic CE of the liver, with successful surgical resection, in a community, North-American hospital.
Case Description/Methods: A 26-year-old Bosnian male presented to the outpatient gastroenterology clinic with right upper quadrant abdominal pain and bloating. Routine laboratory work-up was unremarkable. CT abdomen/pelvis revealed complex cystic lesions in the right and left hepatic lobes. MRI showed hepatomegaly and two cystic liver masses. Suspicion for CE prompted serologic testing, which was positive for Echinococcus IgG. Western blot confirmed these results.
The patient was referred to hepatobiliary surgery. He underwent exploratory laparotomy and attempted PAIR procedure (puncture, aspiration, injection, re-aspiration). This method was unsuccessful due to multiple septations in the cysts, preventing definitive ablation. Instead, both cysts were carefully excised. The patient tolerated the procedure well and was discharged the same day. He returned to the clinic on four separate occasions for post-operative follow-up. Repeat CT abdomen/pelvis showed no residual lesions. His symptoms of abdominal pain and bloating resolved.
Discussion: Humans acquire Echinococcosis via the ingestion of contaminated food or water. Our patient recalled frequenting a fruit stand in Bosnia and eating fresh fruit without washing them prior to ingestion. He believed this is how he acquired the disease. Echinococcosis represents a significant public health issue. This case highlights the importance of prevention, surveillance and early, accurate diagnosis. While de-worming and hygiene programs have been implemented in many underdeveloped, hyperendemic areas, clinicians share in the burden of appropriate disease diagnosis and reporting. Additionally, US physicians bear the moral responsibility to extend discovery data to other countries regarding infective status of their emigrated citizens, as well as contributing to overall surveillance data, in order to promote world-wide disease control.
Disclosures: Mohid Mirza indicated no relevant financial relationships. Janyll Castineira indicated no relevant financial relationships. Karthik Sugumaran indicated no relevant financial relationships. Hussein Osman-Mohamed indicated no relevant financial relationships. Miriam Thomas indicated no relevant financial relationships. Richard Munoz indicated no relevant financial relationships.
Mohid Mirza, DO1, Janyll Castineira, DO2, Karthik Sugumaran, DO1, Hussein Osman-Mohamed, MD1, Miriam Thomas, MD1, Richard Munoz, MD1. P2929 - A Rare Case of Hydatid Disease, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.