Case Report
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jul 14, 2013; 19(26): 4257-4261
Published online Jul 14, 2013. doi: 10.3748/wjg.v19.i26.4257
Alveolar echinococcosis-spreading disease challenging clinicians: A case report and literature review
Georgi Atanasov, Christoph Benckert, Armin Thelen, Dennis Tappe, Matthias Frosch, Dieter Teichmann, Thomas FE Barth, Christian Wittekind, Stefan Schubert, Sven Jonas
Georgi Atanasov, Christoph Benckert, Armin Thelen, Sven Jonas, Department of Visceral, Transplantation, Thoracic and Vascular Surgery, Universitaetsklinik Leipzig, 04103 Leipzig, Germany
Dennis Tappe, Matthias Frosch, Institute of Hygiene and Microbiology, University of Würzburg, 97080 Würzburg, Germany
Dieter Teichmann, Department of Infectious Diseases and Tropical Medicine, Community Hospital Dresden-Neustadt, 01129 Dresden, Germany
Thomas FE Barth, Department of Pathology, Universitaetsklinikum Ulm, 89070 Ulm, Germany
Christian Wittekind, Institute of Pathology, Universitätsklinikum Leipzig, 04103Leipzig, Germany
Stefan Schubert, Department of Gastroenterology and Rheumatology, Universitaetsklinik Leipzig, 04103 Leipzig, Germany
Author contributions: Atanasov G wrote the manuscript, performed literature review and surgical therapy, and collected patient data; Benckert C contributed to surgical therapy and writing the paper; Thelen A performed surgery and contributed to the submission process; Jonas S performed surgery and revised the paper; Schubert S contributed to writing the paper, diagnosis of infection, collecting patient data and follow up of the patient; Wittekind C, Frosch M, Tappe D, Teichmann D and Barth TFE contributed to diagnosis of infection.
Correspondence to: Georgi Atanasov, MD, Resident, Department of Visceral, Transplantation, Thoracic and Vascular Surgery, Universitaetsklinik Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany. georgi.atanasov@medizin.uni-leipzig.de
Telephone: +49-341-9717200 Fax: +49-341-9717209
Received: December 16, 2012
Revised: March 19, 2013
Accepted: April 3, 2013
Published online: July 14, 2013
Processing time: 208 Days and 20.7 Hours
Abstract

Human alveolar echinococcosis (AE) is a potentially deadly disease; recent studies have shown that the endemic area of Echinococcus multilocularis, its causative agent, is larger than previously known. This disease has low prevalence and remains underreported in Europe. Emerging clinical data show that diagnostic difficulties are still common. We report on a 76-year old patient suffering from AE lesions restricted to the left lobe of the liver who underwent a curative extended left hemihepatectomy. Prior to the resection a liver biopsy under the suspicion of an atypical malignancy was performed. After the intervention he developed a pseudoaneurysm of the hepatic artery that was successfully coiled. Surprisingly, during surgery, the macroscopic appearance of the tumour revealed a growth pattern that was rather typical for cystic echinococcosis (CE), i.e., a gross tumour composed of multiple large vesicles with several centimeters in diameter. In addition, there were neither extensive adhesions nor infiltrations of the neighboring pancreas and diaphragm as was expected from previous imaging results. The unexpected diagnosis of AE was confirmed by definite histopathology, specific polymerase chain reaction and serology results. This is a rare case of unusual macroscopic presentation of AE that posed immense diagnostic challenges and had an eventful course. To our knowledge this is the first case of an autochthonous infection in this particular geographic area of Germany, the federal state of Saxony. This report may provide new hints for an expanding area of risk for AE and emphasizes the risk of complications in the scope of diagnostic procedures and the limitations of modern radiological imaging.

Keywords: Alveolar echinococcosis; Echinococcus multilocularis; Autochthonous infection; Liver resection; Hemihepatectomy

Core tip: We describe a rare case of uncommon macroscopic presentation of autochthonous infection with Echinococcus multilocularis that posed immense diagnostic challenges and had an eventful course. To our knowledge this is the first case of an autochthonous infection in this geographic area. This report may deliver new hints for an expanding area of risk for alveolar echinococcosis and emphasizes the risk of complications in the scope of diagnostic procedures and the limitations of modern imaging techniques.