Extensive hydatid cysts involving the lumbosacral vertebrae and pelvis

Highlights

• •A patient with typical hydatid cysts involving both lumbosacral vertebrae and pelvis is presented in this paper.
• •Conservative treatment with antiparasitic medication may improve symptoms.
• •Surgical treatment followed by antiparasitic chemotherapy may reduce the relapse rate of bone hydatid cysts.

Introduction

A 42-year-old woman presented with progressive weakness and numbness of lower extremities, as well as bowel and urinary dysfunction over a 10-year period. The patient lived in a remote village and denied any parasitic disease history. Physical examination demonstrated a large mass in the buttock with tenderness (Fig. 1A). Neurological examination revealed symmetrical hypesthesia below the level of mid-thigh, 4/5 strength on lower limbs, weak patellar tendon and Achilles tendon reflexes. Laboratory tests showed a normal level of C-reactive protein and erythrocyte sedimentation rate, and an elevated eosinophilic granulocyte count (980/ml; reference value, 20–520).

Fig. 1.

(A) Body photograph showed a large mass in the buttock; (B–E) computed tomography images showed severely lytic destruction of the lumbosacral vertebrae and pelvis; (F–H) magnetic resonance images showed multiple cystic lesions in the right psoas muscle, right vastus medialis muscle, spinal canal, and buttock.

Three-dimensional computed tomography images showed a severely bony destruction of the lumbosacral vertebrae and pelvis (Fig. 1B–E). Magnetic resonance images revealed well-defined cystic lesions in the right psoas muscle, buttock, and right vastus medialis muscle (Fig. 1F–H). The imaging findings were pathognomonic for hydatid cyst [1]. Due to the special localization and extensive bone destruction, surgical excision of the lesions became impossible. The patient was prescribed antiparasitic medication (albendazole, 400 mg twice daily) and discharged. At three months follow-up, the patient’s symptoms partly improved.

Hydatid cyst is more frequently involved in the liver and lung, and rarely affects bone [2], [3]. The spinal hydatid cyst is a severe disease associated with a high degree of morbidity and disability. Diagnosis of spinal hydatid cyst is usually delayed as its general course is latent and asymptomatic. Most patients are companied with neurologic deficits when they present to the outpatient. Current treatment options for this disease include medical therapy and surgery [4]. Because of the infiltrative nature of the hydatid cysts, patients carry a high recurrence rate. Despite this disease may not be thoroughly cured, patients who undergo surgical treatment and antiparasitic chemotherapy suffer less relapse rate [5].

CRediT authorship contribution statement

Weibin Sheng designed this study. Shutao Gao and Maimat Fulati collected the data and draft this manuscript. All authors read and approved the final manuscript.

Funding Source

This research did not receive any funding.

Ethical approval

We have reported a case with no requirement for ethical approval.

Consent

Written informed consent was obtained from the patient for this publication.

Conflicts of interest

There are no conflicts of interest.