Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2021; 9(33): 10337-10344
Published online Nov 26, 2021. doi: 10.12998/wjcc.v9.i33.10337
Incurable and refractory spinal cystic echinococcosis: A case report
Tao Zhang, Li-Hua Ma, Hua Liu, Song-Kai Li
Tao Zhang, Hua Liu, Song-Kai Li, Department of Spine Surgery, the 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou 730050, Gansu Province, China
Li-Hua Ma, the First Hospital of Lanzhou University, Lanzhou 730050, Gansu Province, China
Author contributions: Zhang T drafted the manuscript and contributed to the literature search; Ma LH worked on the manuscript, contributed to the literature search, and made suggestions to improve the content; Liu H designed the figures; Li SK supervised the work, contributed to the literature search and worked on the manuscript; all authors have read and approved the final manuscript.
Supported by Chinese People's Liberation Army Medical Technology Youth Training Program, No. 20QNPY071; and the Natural Science Foundation of Gansu Province, No. 21YF1FA179, No. GSWSKY2020-05 and No. 21JR1RA106.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Song-Kai Li, MD, PhD, Chief Doctor, Department of Spine Surgery, the 940th Hospital of Joint Logistics Support Force of Chinese PLA, No. 333 Nanbinhe Middle Road, Qilihe District, Lanzhou 730050, Gansu Province, China. 444124272@qq.com
Received: July 8, 2021
Peer-review started: July 8, 2021
First decision: August 18, 2021
Revised: August 27, 2021
Accepted: September 22, 2021
Article in press: September 22, 2021
Published online: November 26, 2021
Abstract
BACKGROUND

Although the incidence and cure rate of spinal hydatidosis are low, the recurrence rate of spinal hydatidosis is high, and the prognosis of spinal hydatidosis is poor. Therefore, we report a typical case of refractory spinal hydatidosis to increase spine surgeons’ awareness of the disease and reduce misdiagnosis and recurrence.

CASE SUMMARY

A 48-year-old man presented with back pain, significant weight loss, and paralysis of both lower limbs. The patient was misdiagnosed with spinal tuberculosis in an outside hospital. However, spinal magnetic resonance imaging (MRI) showed hyperintense cystic components on T2-weighted images and hypointensity on T1-weighted images. A lobulated, multiocular, honeycomb-appearance, septated cystic mass protruding intraspinally and compressing the spinal cord at segments T8–T9 was present. Paravertebral polycystic lobular lesions presented as a “bunch of grapes”. The ELISA test result for Echinococcus granulosus was positive. Then, a diagnosis of spinal hydatidosis and lung hydatid disease was made, and the patient underwent left transthoracic approach lobectomy, paravertebral lesion debridement, and subtotal vertebrectomy with vertebral body replacement of segments T8 and T9 by a mesh cage. The patient also underwent albendazole chemotherapy before and after surgery. One year after stopping the drug therapy, the patient developed recurrent T5 vertebral lesions and underwent a second subtotal vertebrectomy surgery. The patient is currently in good condition and is receiving long-term medication and follow-up.

CONCLUSION

The MRI feature of a “bunch of grapes” is a typical imaging indication of spinal hydatidosis. Subtotal vertebrectomy is a risk factor for postoperative recurrence. Total spondylectomy makes it possible to cure spinal hydatidosis, but antiparasitic drug therapy is also an important supplementary therapy to multimodal therapy. It is preferable for patients with spinal hydatidosis to receive life-long antiparasitic medication therapy and follow-up.

Keywords: Cystic echinococcosis, Spinal hydatidosis, Recurrence, Case report

Core Tip: We report a rare case of typical refractory spinal hydatidosis. The magnetic resonance imaging finding of a “bunch of grapes” is a typical imaging feature of spinal hydatidosis. Subtotal vertebrectomy is a risk factor for postoperative recurrence. Total spondylectomy makes it possible to cure spinal hydatidosis, but antiparasitic drug therapy is also an important supplementary therapy to multimodal therapy. Preferably, patients with spinal hydatidosis should receive life-long antiparasitic medication therapy and follow-up.