A case of cystic echinococcosis in the liver with 35 years of incubation period.

Cystic echinococcosis is a disease caused by tapeworm Echinococcus granulosus, which had been rarely reported in South Korea. We present the case of Korean patient with hepatic hydatid cyst, who had very long incubation period about 35 years. A 71-year-old male visited our hospital due to abnormal findings of his routine health screenings. He had examination with abdominal ultrasonography three months ago, that revealed a huge hepatic mass. Then, he was admitted to our hospital for further evaluation. At admission, he did not complain of abdominal discomfort and gastrointestinal symptoms such as nausea, vomiting. He was currently taking medications for hypertension and dyslipidemia. He was living in urban area of Busan, South Korea, and denied recent history of travel abroad or consumption of raw or undercooked meat. He did not show any tenderness or rebound tenderness over the right upper quadrant of his abdomen. The initial blood tests were in normal range. Outside CT scan showed the 17 centemeter-sized well defining mass in right lobe of liver with inner multiseptated cystic lesions. And there was no solid lesion or calcification in the hepatic mass. The mass had high signal intensity in T2 phase without diffusion restriction of MRI suggesting the high probability of hydatid cyst. Additional clue for the risk of echinococcosis was obtained from asking about his residence or visit to Middle East country. He stated that he had lived in a rural area in Iraq 35 years ago for working as constructor. He had casual contact with sheeps and dogs and frequently consumed lambs during staying in Iraq. For diagnostic confirmation, the test of Echinococcus immunoglobulin G was performed and result was positive. We diagnosed him as hepatic cystic echinococcosis, stage CE2 according to WHO classification. Surgical resection of the mass was planned with peri-operative anthelminthic treatment. Albendazole 400mg twice daily was administered for 20 days, followed by right lobectomy of liver. Histopathologic examination showed the well-demarcated unilocular cyst containing numerous endocysts. The protoscoleces of the Echinococcus granulosus was found in cystic fluid. He was discharged and planned to have albendazole maintenance treatment for 6 months. The asymptomatic incubation period of the disease can last many years because of helminthic slow growing. History taking should be thorough especially for patients having unproven route of Echinococcosis. [ABSTRACT FROM AUTHOR]