SESSION TITLE: Infections Global Case Reports
SESSION TYPE: Global Case Report Poster
PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM
INTRODUCTION: Hydatid Cyst (HC) is a chronic, complex and neglected zoonotic infection caused by Echinococcus granulosus, a cestode with a worldwide distribution affecting an estimated 1.2 million people, especially in rural communities due to inadequate environmental health, preventive medicine and veterinary services. Although the most frequent localization of first two places are the liver and lungs, HC could be anywhere in the body. Vertebral involvement is uncommon entity even in endemic areas occurring in less than 1% of all HC patients and the diagnosis and treatment is quite challenging [1,2]. Here; we presented a case with vertebral HC extending into the spinal canal.
CASE PRESENTATION: 64-year-old female patient was admitted to our hospital with complaints back pain radiating to the legs, progressive weakness and numbness in hands and the lower limbs, which started about 3 years ago. There was only minimal bilateral lower extremity weakness in physical examinations. Well-defined mass extending into the spinal canal in the posterior mediastinum of left hemithorax and partial destruction of the 4th thoracic vertebral body were found in in radiological studies.Posterolateral thoracotomy was performed through the 4th intercostal space. Diagnosis was verified with pathologically. She was discharged on 9th postoperative day without any complaints and treated with albendazole (10 mg/kg/ daily) for six months. She was symptom free without complications and recurrence one year after surgery
DISCUSSION: Humans are not involved in the natural cycle of the cyst and become accidentally aberrant intermediate hosts by digesting eggs. After ingestion, HC switches to the bloodstream via portal vein. Eventually they are trapped in liver and lungs. A few HCs can escape into the systemic circulation; however, in only 10% of all cases, it is responsible for the rare localization [2,3]. Vertebral involvement is quite interesting compared with the common settlements. When it occurs, marrow cavities and spongiosa of the spine is occupied by them that causes extensive bone erosion and penetrations into the spinal canal. The gradually growing is often well tolerated until it causes neurological dysfunction as extremity weakness or paralysis
CONCLUSIONS: Vertebral HC is life-threatening with high mortality. Even after repeated surgery and chemotherapy it has a high recurrence rate ranging from 40% to 100% and progressive destructive nature which makes it almost impossible to treat the disease . To improve good clinical results and decrease the recurrence rate; newer surgical methods and more efficient drugs which have better penetrating to the bones are needed.
Reference #1: Brunetti E, Garcia HH, Junghanss T (2011) Cystic echinococcosis: chronic, complex, and still neglected. PLoS Negl Trop Dis 5: e1146
Reference #2: Kaloostian PE, Gokaslan ZL Spinal Hydatid Disease: A Multidisciplinary Pathology. World Neurosurg. 2015 Jan;83(1):52-3.
Reference #3: Ozgonul A, Sogut O, Cece H, Aydın S, Kürkcüoglu IC.Co-occurrence of diaphragmatic and serratus anterior muscle hydatidosis: an unusual localization. J Emerg Med. 2012 Oct;43(4):e219-22.
DISCLOSURE: The following authors have nothing to disclose: Mustafa Calik, Saniye Calik, Hidir Esme
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