[Hepatic echinococcosis that required 11 years for a definitive diagnosis: a case report].

A woman in her 80s underwent computed tomography that revealed a 22-mm-sized unilocular mass in segment 4 of her liver. The mass grew to 26mm at the 4-year follow-up and to 36mm at the 11-year follow-up, becoming a multilocular mass that invaded the bile duct. At this point, the patient was diagnosed with hepatic echinococcosis based on a serological examination and oral albendazole treatment was initiated. The patient developed cholangitis and underwent endoscopic biliary stenting 12 years after her initial diagnosis. We consider this case valuable as it allowed us to follow the natural course of hepatic echinococcosis.

LncRNA Regulation Mechanism in Hepatic Alveolar Echinococcosis with Nanosecond Pulse.

BACKGROUND: The mortality of patients infected with hepatic alveolar echinococcosis (HAE) was higher. The aim of this study was to investigate the therapeutic effect of nanosecond pulsed electric fields (nsPEFs) on HAE in rats and explore the related molecular mechanisms. METHODS: Establishment of HAE rat model and the lesions were treated with nsPEFs. The RNA of lesions in the high voltage nsPEFs treatment group and model group were extracted, and lncRNA and mRNA sequence analyses was performed. After obtaining the differentially expressed lncRNAs and mRNAs between the two groups, enrichment analysis was performed for mRNAs. The target genes of lncRNAs were predicted through co-location and co-expression. The expression of important lncRNAs and target genes in lesions was detected by qPCR. RESULTS: The HAE rat model was successfully established. After nsPEFs treatment, the size of lesions was improved significantly. Then, we identified 270 differentially expressed lncRNAs and 1659 differentially expressed mRNAs between the high voltage nsPEFs treatment group and model group. Enrichment analysis showed that the differentially expressed mRNAs were mainly enriched in metabolism and inflammation. Five important lncRNAs regulatory networks were identified, then Cpa1, Cpb1, Cel, Cela2a, and Cela3b were identified as key target genes. Importantly, the expression of 5 lncRNAs and 5 target genes was verified in the lesions. CONCLUSIONS: Preliminary results had shown that HAE treatment with nsPEFs can inhibit the growth of lesions. NsPEFs treatment altered gene expression in the lesions, and some genes were regulated by lncRNAs. The therapeutic mechanism may involve metabolism and inflammation.

[2023 update on alveolar echinococcosis]. / Échinococcose alvéolaire : prise en charge en 2023.

Alveolar echinococcosis is a rare but severe parasitic disease and is now in Europe the parasitic infection associated with the most morbidity and mortality. Its prevalence is increasing in Switzerland in both urban and rural areas. Echinococcosis is a differential diagnosis that should be considered when facing a cystic hepatic lesion. Moreover, this parasitic infection is increasing amongst immunocompromised patients, making the diagnosis more complex, because of atypic lesions and a more rapid evolution. At the current time, several treatment options, both surgical and medical, can offer patients a good prognosis and maintain a good quality of life.

L'échinococcose alvéolaire est une parasitose rare mais sévère. En Europe, il s'agit de l'infection parasitaire causant le plus de morbimortalité. Son incidence est en augmentation en Suisse dans les zones urbaines et rurales. L'échinococcose est donc un diagnostic différentiel à évoquer face à une lésion kystique hépatique. En outre, cette infection parasitaire est en augmentation chez les patients immunosupprimés, chez qui le diagnostic est plus complexe en raison de lésions atypiques et d'une évolution plus rapide. À l'heure actuelle, plusieurs modalités de traitements chirurgicaux et médicamenteux permettent d'offrir un bon pronostic aux patients tout en maintenant une bonne qualité de vie.

Diagnosis, treatment, and outcome of four dogs with alveolar echinococcosis in the northwestern United States.

OBJECTIVE: To describe the clinical disease, diagnostic findings, medical management, and outcome in dogs with alveolar echinococcosis (AE). ANIMALS: 4 dogs with naturally occurring AE. PROCEDURES: Medical records were retrospectively reviewed from 2020 to 2022 to identify dogs diagnosed with AE. Signalment, case history, clinical signs, imaging and pathological laboratory findings, treatment, and clinical outcome were reported. RESULTS: All dogs developed systemic clinical illness and weight loss. Abdominal ultrasonography revealed multifocal to coalescent cystic masses of variable size distributed throughout the liver in all cases. Evaluation of aspirated hepatic cyst contents included membranous parasite structures and calcareous corpuscles. Echinococcus multilocularis was confirmed via PCR from hepatic cyst fluid in 3 of 4 cases. Treatment included systemic benzimidazole and praziquantel administration, 1 or more instances of ultrasound-guided cyst drainage in all cases, with ethanol ablation (percutaneous aspiration-injection-reaspiration) in 2 cases, and surgical resection in 1 case. Two of 4 dogs were euthanized within 5 months of diagnosis. One of these dogs was necropsied and had nearly complete obliteration of the hepatic parenchyma by multilocular cystic masses. One dog is still alive, and 1 dog has been lost to follow-up. CLINICAL RELEVANCE: This series of cases highlighted the diagnostic findings and therapeutic intervention in 4 dogs with AE. This was the first report of medical management incorporating the percutaneous aspiration-injection-reaspiration method used in humans. Reports of canine AE are rare in the US, so this series serves to help raise awareness of hepatic AE in the northwestern US.

Echinococcus multilocularis specific antibody, systemic cytokine, and chemokine levels, as well as antigen-specific cellular responses in patients with progressive, stable, and cured alveolar echinococcosis: A 10-year follow-up.

BACKGROUND: The infestation with Echinococcus multilocularis larvae may persist in humans for up to decades without evident clinical symptoms. Longitudinal investigations are needed to understand the dynamic immunological processes in alveolar echinococcosis (AE) patients associated with an active and progressive, a stable or a regressive course of disease. METHODOLOGY/PRINCIPAL FINDINGS: This study evaluated the E. multilocularis specific antibody responses, systemic cytokine, and chemokine serum levels over a 10-year follow-up period, as well as cellular responsiveness in AE patients. Our results demonstrate a rapid decrease in antibodies against E. multilocularis specific antigen Em2+. Especially in cured patients, these antibodies remained negative, making them a significant predictor for cured AE. E. multilocularis specific IgG4, and indirect hemagglutination IHA decreased later in time, after around 5 years. While total IgE did not show significant dynamics over the course of disease, E. multilocularis specific IgE decreased after one to two years, and increasing levels were a significant predictor of progressive disease. There was no significant change in systemic IL-8, IL-9, CCL18 or CCL20 serum levels over time. Univariate analysis across groups indicated lower IL-8 levels in cured patients; however, this result could not be confirmed by multivariate analysis. Levels of CCL17 decreased during treatment, especially in cured patients, and thus might serve as a predictive or risk factor for progressive disease. Levels of IL-10 and CCL13 decreased during disease, especially after five and ten years of intervention. The E. multilocularis antigen (EmAg) inducible cellular productions of MCP1(CCL13), TARC(CCL17) and PARC(CCL18) were lowest in patients with cured AE and infection-free controls, while the EmAg inducible cellular production of IFN-γ increased after cure. Significant positive cytokine and chemokine correlations were observed in AE patients for IL-9, IL-10, CCL13(MCP-4), CCL17(TARC) and CCL20(LARC)(for all p<0.001). E. multilocularis specific IgG4 response correlated positively with TARC (p<0.001). Both markers enhanced over time in progressive disease and decreased after cure. The levels of IL-8, IL-10, MCP4 and LARC enhanced with AE regression. CONCLUSIONS/SIGNIFICANCE: Repeated biomarker surveys are advisable to evaluate progression or regression of disease during longitudinal follow-up and such analyses can support imaging techniques and improve staging of AE patients.

Revisión del diagnóstico y manejo del quiste hidatídico hepático / Review of diagnosis and management of hydatid cyst of the liver

La hidatidosis es una zoonosis causada por el estado larvario de Echinococcus. Los seres humanos son huéspedes intermediarios accidentales, donde produce lesiones quísticas, principalmente en hígado y pulmón. Suele ser asintomática, por lo que se suele detectar de forma incidental. Los síntomas se deben a la expansión del quiste y/o a la reacción inflamatoria. El signo más frecuente es la hepatomegalia. No produce alteraciones analíticas específicas pero existeninmunodiagnósticos que pueden complementar su estudio, siendo la detección de anticuerpos el método de elección. Aunque la ecografía es la principal técnica para su diagnóstico, la tomografía brinda información más precisa respecto a sus características y relaciones anatómicas. Actualmente hay varias opciones terapéuticas. El tratamiento con albendazol, combinado o no con prazicuantel, es útil en los quistes pequeños (< 5 cm) sin complicaciones. Solo el 30 % de los quistes desaparecen con tratamiento médico exclusivo. La cirugía está indicada en los quistes hepáticos grandes (> 10 cm), con riesgo de ruptura y/o complicados; el abordaje laparoscópico está poco generalizado. La técnica radical (quistoperiquistectomía total) es preferible dado el menor riesgo postoperatorio de infecciones abdominales, fístulas biliares y morbilidad global. Las técnicas conservadoras son adecuadas en las áreas endémicas donde la cirugía la realizan cirujanos no especializados. La PAIR (punción-aspiración-inoculación-reaspiración) es una técnica innovadora que representa una alternativa a la cirugía. Está indicada en los pacientes inoperables y/o que rechazan la cirugía, en caso de recidiva tras la cirugía y cuando hay ausencia de respuesta al tratamiento médico. En los casos en que se demuestran quistes quiescentes o inactivos no complicados, se puede realizar una vigilancia activa sin tratamiento. (AU)

A review of the diagnosis and management of liver hydatid cyst.

Hydatidosis is a zoonosis caused by Echinococcus in the larval stage. Humans are accidental intermediary hosts where cystic lesions develop, primarily in the liver and the lungs. It is usually asymptomatic, hence it often represents an incidental finding. Symptoms result from cyst expansion and/or host inflammatory reaction. Hepatomegaly is the most common sign. Hydatidosis induces no specific changes in lab tests but immunodiagnostics are available that may complement its study, with antibody detection being the modality of choice. While ultrasound is the main diagnostic technique, tomography offers more accurate information regarding both characteristics and anatomical relations. A number of therapy options are presently available. Treatment with albendazole, whether combined or not with praziquantel, is useful for smaller, uncomplicated cysts (< 5 cm). Only 30 % of cysts disappear with medical treatment alone. Surgery is indicated for bigger liver cysts (> 10 cm), and cysts at risk of rupture and/or complicated cysts. The laparoscopic approach is scarcely widespread. The radical technique (total cystopericystectomy) is preferable because of its lower risk for postoperative abdominal infection, biliary fistula, and overall morbidity. Conservative techniques are appropriate in endemic areas where surgery is performed by nonspecialist surgeons. PAIR (puncture-aspiration-injection-reaspiration) is an innovative technique representing an alternative to surgery. It is indicated for inoperable cases and/or patients who reject surgery, for recurrence after surgery, and for lack of response to medical treatment. Active surveillance without treatment may be indicated for quiescent or inactive, uncomplicated liver cysts.

Hepatic Alveolar Echinococcosis.

Hepatic alveolar echinococcosis (HAE) is a rare but severe zoonosis caused by the pseudotumoral intrahepatic development of the larval stage of the tapeworm Echinococcus multilocularis. HAE is present only in the Northern Hemisphere, predominantly in China. Currently, there is a significant resurgence of cases in historically endemic areas associated with emergence of HAE in countries not previously concerned. Today, in European countries, HAE is often discovered by chance; however, clinicians should be made aware of opportunistic infections that progressively emerged recently as a result of therapeutic or pathological immunosuppression. Ultrasonography is the key first-line diagnostic procedure, with specific serology providing confirmation in 95% of the cases. Albendazole, only parasitostatic, is the mainstay for treatment. Surgical resection, if feasible, is the gold standard for treatment, and more patients are currently eligible for this option because of an earlier diagnosis. The prognosis has considerably improved but remains poor in countries where access to care is less favorable.

Concomitant Presence of Hydatid Cyst and Colorectal Liver Metastasis

A 65-year-old man, with signs of acute colon obstruction, was diagnosed with rectal tumour and liver hydatid cyst. Additionally, a focal liver lesion in segment 1 was detected. Moreover, physical examination revealed hepatomegaly and abdominal distension. Thus, rectal resection and small liver lesion biopsy was performed. Serological and pathohistological analyses showed concomitant presence of hydatid cyst and colorectal metastasis in the liver. Hence, the cyst was treated with anthelmintic therapy, and patient lived another year after the diagnosis. To the best of our knowledge, cases of concomitant hydatid cyst and colorectal liver metastasis has never been reported; thus, this article addresses a unique case of coexistence between these two serious liver diseases.

Infected hepatic echinococcosis. Clinical, therapeutic, and prognostic aspects. A systematic review.

Infected hepatic echinococcosis (IHE), defined as a cystic infection, and the development of a liver abscess may be a complication in the natural history of hepatic echinococcosis. The aim of this study was to review the evidence available related to clinical, therapeutic, and prognostic aspects of IHE. We conducted a systematic review. Trip Database, BIREME-BVS, SciELO, LILACS, IBECS, PAHO-WHO; WoS, EMBASE, SCOPUS and PubMed were consulted. Studies related to IHE in humans, without language restriction, published between 1966 and 2020 were considered. Variables studied were publication year, geographical origin of the samples, number of patients, therapeutic and prognosis aspects, and methodological quality (MQ) for each article. Descriptive statistics was applied. Subsequently, weighted averages (WA) of the MQ of each article were calculated for each variable of interest. 960 related articles were identified; 47 fulfilled selection criteria, including 486 patients with a median age of 48 years, 51.6% being male. The largest proportion of articles were from Spain, India, and Greece (36.1%). Mean cyst diameter was 14.1 cm, and main location was right liver lobe (74.0%). WA for morbidity, mortality, hospital stay, and follow-up were 28.5%, 7.4%, 8.5 days and 14.8 months, respectively. The most common causative microorganisms of superinfection isolated were Enterobacteriaceae. An association with cholangitis was reported in 13.4% of cases. Mean MQ of the 47 articles included was 7.6 points. We can conclude that the information related to IHE is scarce and scattered throughout articles of small casuistry and poor quality, and consequently does not provide strong evidence.

Relevance of Pulmonary Alveolar Echinococcosis / Relevancia de equinococosis alveolar con afectación pulmonar

BACKGROUND: Pulmonary alveolar echinococcosis (PAE) is a chronic disease caused by Echinococcus multilocularis with very low incidence in developed countries. METHODS: This single-center, retrospective study included 34 patients who were diagnosed with PAE between January 2001 and February 2019 (15 males, 19 females, mean age: 52.4 ± 15.8 years, age range: 28-78 years) in Ataturk University Medical School, Erzurum, Turkey. RESULTS: The liver was the primary involved organ in all cases. Pulmonary involvement was detected in 13.0% (34/261) of all cases with hepatic alveolar echinococcosis (AE), and three patients (8.8%) had both pulmonary metastasis and brain metastasis. The route of spread to the lungs based on radiological data was hematogeneous in 25 patients (73.5%), transdiaphragmatic in three patients (8.8%) and both hematogeneous and transdiaphragmatic in six patients (17.7%). AE showed bilateral involvement in 19 patients (55.9%), whereas only the right lung was involved in 12 patients (35.3%) and the left lung in three patients (8.8%). Of the patients, five underwent surgery due to PAE and 29 patients received medical therapy with albendazole. A total of three patients died during the follow-up period (2, 5 and 10 years after the diagnosis of PAE), while 31 patients continued with follow-up and treatment for a mean duration of 5.4 ± 3.8 years (1-14 years). CONCLUSIONS: Patients with hepatic AE must, as a matter of course, be screened for possible lung involvement. Albendazole therapy may slow down disease progression in patients with widespread pulmonary involvement who are not eligible for surgery

INTRODUCCIÓN: La equinococosis alveolar con afectación pulmonar (PAE) es una enfermedad crónica causada por Echinococcus multilocularis, cuya incidencia es muy baja en los países desarrollados. MÉTODOS: Estudio unicéntrico, retrospectivo en el cual se diagnosticaron 34 pacientes con PAE entre enero de 2001 y febrero de 2019 (15 varones y 19 mujeres, edad media: 52,4 ± 15,8 años, rango de edad: 28-78 años) en la Escuela Médica Univesitaria de Ataturk, Erzurum, Turquía. RESULTADOS: En el total de los casos incluidos en el estudio el hígado fue el principal órgano afectado. La afectación pulmonar se detectó en el 13% (34/261) de los casos con equinococosis alveolar (AE), y 3 pacientes (8,8%) presentaron tanto metástasis pulmonar como cerebral. De acuerdo con los datos radiológicos, la propagación a los pulmones fue por vía hematógena en 25 pacientes (73,5%), transdiafragmática en 3 pacientes (8,8%) y tanto hematógena como transdiafragmática en 6 pacientes (17,7%). Diecinueve pacientes (55,9%) presentaron PAE con afectación pulmonar bilateral, mientras que 12 pacientes (35,3%) presentaron afectación solo del pulmón derecho y 3 (8,8%) solo del izquierdo. De todos los pacientes, 5 fueron sometidos a cirugía debido a la PAE y 29 recibieron tratamiento médico con albendazol. Tres pacientes fallecieron durante el período de seguimiento (2,5 y 10 años después del diagnóstico de PAE), mientras que 31 continuaron con el seguimiento y el tratamiento durante 5,4±3,8 años de media (1-14 años). CONCLUSIONES: Los pacientes con AE hepática se deben cribar de manera rutinaria para detectar una posible afectación pulmonar. El tratamiento con albendazol puede ralentizar la progresión de la enfermedad en pacientes con afectación pulmonar extendida que no son aptos para cirugía

[Anaphylaxis due to a ruptured hydatid cyst]. / Anaphylaxie bei rupturierter Echinokokkuszyste.

HISTORY AND CLINICAL FINDINGS: We report the case of a 27-year-old Syrian patient who came to the emergency department with a syncopal episode. No medical history could be raised due to a language barrier and so the clinical presentation was leading. INVESTIGATIONS AND DIAGNOSIS: The patient exhibited signs of shock, accompanied by an exanthema as well as perioral hematin. In an ultrasound sonography free intraabdominal fluid and an obscure change in the upper abdomen could be visualized. An esophagogastroduodenoscopy showed evidence of an ulcer, however did not explain all symptoms. In a CT abdomen, signs of a ruptured cyst could be demonstrated. TREATMENT AND COURSE: The patient stabilized under the treatment protocol for anaphylaxis. Due to the clinical course and country of origin the patient received albendazole and a partial liver resection for a suspected echinococcus cyst. CONCLUSION: Obscure clinical symptoms alongside signs of shock, should always considered to be an allergic reaction in absence of sepsis or hemorrhage. In anaphylaxis, echinococcosis should always be included in the differential diagnosis.

Comparison of the Long-Term Results of Puncture, Aspiration, Injection and Re-aspiration (PAIR) and Catheterization Techniques for the Percutaneous Treatment of CE1 and CE3a Liver Hydatid Cysts: A Prospective Randomized Trial.

PURPOSE: To evaluate and compare the results of puncture, aspiration, injection and re-aspiration (PAIR) and catheterization techniques for treatment of CE1 and CE3a liver hydatid cysts according to World Health Organization classification. MATERIALS AND METHODS: Forty patients (29 females) with 56 liver CE1and CE3a cysts were prospectively randomized and enrolled into 2 groups by sealed envelope method. Procedures were performed under general anesthesia. Several parameters including technical success (completing procedure steps), clinical success (lack of recurrence on follow-up), major and minor complications, long-term changes of cyst cavities and length of hospital stay were compared between two groups. RESULTS: As in 2 patients with 3 cysts, PAIR technique had to be changed to catheterization technique due to technical reasons. The technical success rates were 91.9% and 100% for PAIR and catheterization groups, respectively. Volume decrease rates were 78.5% and 86.8% in PAIR and catheterization groups, with a mean follow-up of 78.1 and 71 months, respectively. There was no mortality, anaphylactic shock or intraabdominal dissemination. The rate of major complications such as abscess, cysto-biliary fistula and recurrence was 2.94% and 36.84% in PAIR and catheterization groups, respectively (p = 0.002). Median length of hospital stay was shorter in PAIR group (1 vs 4 days) (p = 0.015). CONCLUSION: PAIR technique should be preferred to catheterization technique for treatment of liver CE1 and CE3a cysts due to lower rates of major complications and length of hospital stay. Catheterization technique should be employed when cysto-biliary fistula was evident.

Hepatic Cystic Echinococcosis (Hydatid Cyst) in a Six Year Old.

Presentation To describe a case of cystic echinococcosis (CE) in a previously healthy child and review epidemiology of CE in Ireland. Diagnosis A previously healthy 6 year old girl was found to have a cystic lesion in the right lobe of her liver. Serology for Echinococcus granulosus was positive, and radiological features were suggestive of CE. Treatment The patient was pre-treated with anti-helminthic medications before undergoing a liver segmentectomy to remove the cyst, and received further treatment with albendazole after surgery. Histological findings were consistent with CE due to E. granulosus, likely acquired during travel to continental Europe. Conclusion CE should be considered in the differential of children with asymptomatic cysts in the liver and/or lung, and a travel history elucidated in such cases.

Successful surgical management of hepatic alveolar echinococcosis by inductive therapy with albendazole - a case report.

We report the case of a 65-year-old female patient with hepatic alveolar echinococcosis (AE) caused by Echinococcus multilocularis. This infrequent zoonosis has a considerable morbidity and mortality. The malignant appearing hepatic mass was initially misdiagnosed as cholangiocarcinoma of the right hepatic lobe (segments VII, VIII, and IVa, sized 10.9 cm × 7.6 cm) involving the right and middle hepatic vein and extending close to the left hepatic vein. During exploratory laparotomy, the frozen-section biopsy was indicative of AE (World Health Organization [WHO] classification: stage P3N0M0). Due to the high operative risk, it was decided to pretreat the patient with albendazole as inductive therapy in order to remove the AE secondarily in accordance with the patient's request. After year-long treatment with albendazole (under strict control of the maximum blood levels), a right hemihepatectomy was successfully performed. Postoperative treatment with albendazole had to be stopped prematurely after 11 months due to considerable subjective intolerance and a more-than-tenfold elevation of transaminases despite normal therapeutic albendazole blood levels. A 18F-FDG-PET/CT scan revealed no evidence of AE residues. Conducting follow-up examinations by 18F-FDG-PET/CT scans every 2 years is planned in order to recognize possible recurrence at an early stage.

Imported hepatopulmonary echinococcosis: first report of Echinococcus granulosus sensu stricto (G1) in Bolivia.

Hepatopulmonary hydatidosis in young children is a rare and atypical presentation of Echinococcus granulosus infection. We report the first case of cystic echinococcosis caused by a microvariant of E. granulosus sensu stricto. Chemotherapy and systemic corticoids were administered before curative surgery was performed. Recurrence was not observed for more than 24 months of follow-up.

Immune Exhaustion of T Cells in Alveolar Echinococcosis Patients and Its Reversal by Blocking Checkpoint Receptor TIGIT in a Murine Model.

BACKGROUND AND AIMS: The cestode Echinococcus multilocularis infection, a serious health problem worldwide, causes alveolar echinococcosis (AE), a tumor-like disease predominantly located in the liver and able to spread to any organs. Until now, there have been few studies that explore how T-cell exhaustion contributes to the parasite's escape from immune attack and how it might be reversed. APPROACH AND RESULTS: In this study, we found that liver T-cell immunoreceptor with immunoglobulin and immunoreceptor tyrosine-based inhibitory motif domain (TIGIT) expression was significantly enhanced and positively correlated with lesion activity in AE patients. High TIGIT expression in both liver-infiltrating and blood T cells was associated with their functional exhaustion, and its ligand CD155 was highly expressed by hepatocytes surrounding the infiltrating lymphocytes. In co-culture experiments using human blood T cells and hepatic cell line HL-7702, CD155 induced functional impairment of TIGIT+ T cells, and in vitro blockade with TIGIT antibody restored the function of AE patients' T cells. Similar TIGIT-related functional exhaustion of hepatic T cells and an abundant CD155 expression on hepatocytes were observed in E. multilocularis-infected mice. Importantly, in vivo blocking TIGIT prevented T-cell exhaustion and inhibited disease progression in E. multilocularis-infected mice. Mechanistically, CD4+ T cells were totally and CD8+ T cells partially required for anti-TIGIT-induced regression of parasite growth in mice. CONCLUSIONS: This study demonstrates that E. multilocularis can induce T-cell exhaustion through inhibitory receptor TIGIT, and that blocking this checkpoint may reverse the functional impairment of T cells and represent a possible approach to immunotherapy against AE.

Imported hepatopulmonary echinococcosis: first report of Echinococcus granulosus sensu stricto (G1) in Bolivia

Abstract Hepatopulmonary hydatidosis in young children is a rare and atypical presentation of Echinococcus granulosus infection. We report the first case of cystic echinococcosis caused by a microvariant of E. granulosus sensu stricto. Chemotherapy and systemic corticoids were administered before curative surgery was performed. Recurrence was not observed for more than 24 months of follow-up.