Fatal Liver and Lung Alveolar Echinococcosis with Newly Developed Neurologic Symptoms due to the Brain Involvement

Abstract

The fox tapeworm Echinococcus multilocularis causes human alveolar echinococcosis, commonly affecting the liver. However, in ∼1% of cases, systematic spread of the disease involves the brain as well. A patient had a 6-year history of liver and lung alveolar echinococcosis that was considered not suitable for surgery, and treatment with albendazole was introduced. After the appearance of neurologic disturbances, an intracranial mass lesion was demonstrated by radiologic imaging. The lesion was surgically removed, and histologic analysis revealed metacestode tissue of E. multilocularis. Despite the surgical resection of the lesion, the patient died of progression of systemic alveolar echinococcosis. The authors highly recommend implementing neurologic monitoring to the follow-up algorithm for patients with systemically disseminated alveolar echinococcosis. When neurologic symptoms occur, radiologic imaging of the brain should be obtained immediately. Surgery should be considered for all intracranial echinococcal lesions, unless the lesion is located in the eloquent brain area.

Keywords

alveolar echinococcosis - Echinococcus multilocularis - cerebral alveolar echinococcosis

• References

• 1 Kern P, Wen H, Sato N. , et al. WHO classification of alveolar echinococcosis: principles and application. Parasitol Int 2006; 55 (Suppl): S283-S287
• 2 Algros MP, Majo F, Bresson-Hadni S. , et al. Intracerebral alveolar echinococcosis. Infection 2003; 31 (01) 63-65
• 3 Ozdemir NG, Kurt A, Binici DN, Ozsoy KM. Echinococcus alveolaris: presenting as a cerebral metastasis. Turk Neurosurg 2012; 22 (04) 448-451
• 4 Ozdol C, Yildirim AE, Daglioglu E, Divanlioglu D, Erdem E, Belen D. Alveolar hydatid cyst mimicking cerebellar metastatic tumor. Surg Neurol Int 2011; 2: 13
• 5 Senturk S, Oguz KK, Soylemezoglu F, Inci S. Cerebral alveolar echinoccosis mimicking primary brain tumor. AJNR Am J Neuroradiol 2006; 27 (02) 420-422
• 6 Tappe D, Weise D, Ziegler U, Müller A, Müllges W, Stich A. Brain and lung metastasis of alveolar echinococcosis in a refugee from a hyperendemic area. J Med Microbiol 2008; 57 (Pt 11): 1420-1423
• 7 Aydinli B, Aydin U, Yazici P, Oztürk G, Onbaş O, Polat KY. Alveolar echinococcosis of liver presenting with neurological symptoms due to brain metastases with simultaneous lung metastasis: a case report. Turkiye Parazitol Derg 2008; 32 (04) 371-374
• 8 Ma L, Liu WK, Mao BY, Zhang YK. An Echinococcosis multilocularis presenting as a giant anterior cranial basilar tumor. Neurol Sci 2009; 30 (03) 247-249
• 9 Wang J, Cai B, You C. Surgical treatment options for cerebral alveolar echinococcosis: experience in six patients. Neurol India 2009; 57 (02) 157-161
• 10 Tunaci M, Tunaci A, Engin G, Ozkorkmaz B, Ahishali B, Rozanes I. MRI of cerebral alveolar echinococcosis. Neuroradiology 1999; 41 (11) 844-846
• 11 Ihara T, Imai T, Saito H, Tashiro K, Onmura Y. Cerebral alveolar hydatid cyst—case report. Neurol Med Chir (Tokyo) 1991; 31 (06) 342-345
• 12 Walker MD, Zunt JR. Neuroparasitic infections: cestodes, trematodes, and protozoans. Semin Neurol 2005; 25 (03) 262-277
• 13 Eckert J, Deplazes P. Biological, epidemiological, and clinical aspects of echinococcosis, a zoonosis of increasing concern. Clin Microbiol Rev 2004; 17 (01) 107-135
• 14 Reuter S, Jensen B, Buttenschoen K, Kratzer W, Kern P. Benzimidazoles in the treatment of alveolar echinococcosis: a comparative study and review of the literature. J Antimicrob Chemother 2000; 46 (03) 451-456
• 15 Schmid M, Pendl G, Samonigg H, Ranner G, Eustacchio S, Reisinger EC. Gamma knife radiosurgery and albendazole for cerebral alveolar hydatid disease. Clin Infect Dis 1998; 26 (06) 1379-1382
• 16 Aoki T, Hagiwara M, Yabuki H, Ito A. Unique MRI findings for differentiation of an early stage of hepatic alveolar echinococcosis. BMJ Case Rep 2015;