A RARE CASE OF HYDATID CYST WITH CENTRAL NERVOUS SYSTEM INVOLVEMENT.

Introduction: Hydatid cyst is a very rare disease in our days and furthermore central Nervous system involvement is uncommon. Case Report: We present the case of a 46 years old patient that was admitted to the emergency department with complaints of new onset of nonsensical movements, speech and inability to recognize his relatives. He had no known comorbidities. He had been on oral ornidazole and naproxen for two weeks for hydatid cyst and an operation was planned. On physical examination, he was unoriented and incoherent. In laboratory results, hemoglobin level was low; platelets were normal; leukocytes, CRP, ALT, AST, ALP, GGT, bilirubins were elevated. The preliminary report of brain CT imaging was interpreted as normal and In the preliminary report of brain MRI Hydatid cyst was interpreted as central involvement. Lumbar puncture could not be performed in the emergency department because of high INR. Two sets of blood cultures were obtained, Albendazole 2*400 mg; ceftriaxone 2*2000 mg iv and vancomycin 4*500 mg iv were started. Infective endocarditis screening tests were requested. He was hospitalized in the intensive care unit and follow-up was started. He developed a fever in the intensive care unit. Brain MRI report was evaluated in favor of foreground abscess foci. Metronidazole 4*500 mg iv was added to the treatment. Also Streptococcus intermedius was found in the blood culture and gentamicin 5mg/kg was started. The dynamic CT imaging of the liver revealed that intra-abdominal ascites was observed in the preliminary interpretation. The patient underwent paracentesis and leukocytosis was present in the sample cell count. Radiology was consulted again and rupture of one of the abscess foci in the left liver was suspected. The patient underwent emergency operation and five liters of intra-abdominal abscess material was drained. Fluconazole 1*400 mg iv was added. Echocardiography performed for endocarditis revealed no vegetation. The patient was transferred from ICU to gastroenterology clinic. Discussions : The presence of multiple infections in a patient with a Hydatid Cyst can pose challenges in treatment and selecting the appropriate medication. Effective management requires a multidisciplinary approach involving medical specialties such as Infectious Diseases, Intensive Care, Gastroenterology, General Surgery and Radiology. Conclusions: During the follow-up, ESBL positive Klebsiella pneumonıae was grown in sputum culture. Ceftriaxone was discontinued and changed with meropenem 3*2000 mg iv. The patient was evaluated with control tomography imaging and discharged with completely healing. [ABSTRACT FROM AUTHOR]