Autor : Albuja-Hidalgo, Andrea1, Almeida-Arostegui, Nicolas2
1 Pulmonology Service, Hospital Universitario de Torrejsn, Madrid, Espaqa 2Radiology Service, Hospital Universitario Nuestra Seqora del Rosario, Madrid, Espaqa
https://doi.org/10.56538/ramr.TZBI7342
Correspondencia : Andrea Albuja Hidalgo Servicio de Neumologma, Hospital Universitario de Torrejsn, Madrid, Espaqa E-mail: andrealbuja90@gmail.com
Recibido:05/04/2024
Aceptado:09/10/2024
CASE DESCRIPTION
A 39-year-old man, former smoker,
originally from Romania, comes to the emergency room due to several episodes of
self-limiting hemoptoic sputum and one instance of
sputum with a membranous structure reminiscent of egg white texture (Image 1:
Scolices). The patient had undergone lung surgery in
adolescence but does not recall the diagnosis or reason for it. His history
includes exposure to sheep, dogs, cows, and foxes during childhood.
Physical examination revealed a
baseline oxygen saturation of 96%, and lung auscultation was normal. The chest
X-ray revealed bilateral nodular opacities. A chest computed tomography (CT)
scan showed multiple pulmo-nary nodules with liquid density, some of which were
multiloculated with the classic appearance of
daughter cysts, many of them with peripheral calcifications1
(Image 2: Hydatid cysts).
Laboratory findings were
unremarkable except for a slight elevation in eosinophils,
at 6.7% (0.5%-5.5%).
DIAGNOSIS AND DISCUSSION
After being discharged from the
hospital with empirical antibiotic therapy, the patient continued evaluation in
pulmonology consultations, where a bronchoscopy with bronchoalveolar
lavage was performed but did not yield any microbiological isolates.
A serology test for Echinococcus was requested, yielding a positive result for IgG against Echino-coccus multilocularis: 3.63 (reference range: 0-1.1), and a
positive result for the Em18:22 antigen (also positive for Em95:36 and EgAgB:216), confirming acute alveolar echinococcosis.
Given the presence of bilateral
pulmonary hyda-tid cysts, the patient was not a
candidate for sur-gical or percutaneous management. Therefore, it was decided
to initiate treatment with albendazole 200 mg twice
daily and praziquantel 2400 mg once a week for
approximately six months, with periodic serological tests. After two months of
treatment, the patient experienced nausea and dizziness as side effects of praziquantel. The decision was made to reduce the dose of praziquantel by half, so the patient started to receive
1200 mg of praziquantel along with albendazole, which improved tolerance.
After several months of
treatment, the patient provided a report from Romania indicating that he had
required surgical resection of a right-sided hydatid
cyst in his adolescence, which resulted in a postoperative complication of
rupture and spillage of its contents. This complication is probably the cause
of the spread of the cyst contents to both lungs and the pleura, now resulting
in dissemi-nated pulmonary hydatidosis.
A follow-up chest CT scan was
performed twelve months into treatment (Image 3: post-treatment hydatid cysts) and showed a significant reduction in the
cysts located in the left upper and lower lobes. Serology also revealed
improvement: IgG for Echinococcus
multilocularis (2.75), Em
18 (17), Em 95 (18), EgAgB
(204); IgG1 levels (402-715) dropped from 1160 to 897, and IgG4 levels (3.9-
86.4) decreased from 405 to 156.
There is currently insufficient
evidence for a standardized treatment for disseminated pulmo-nary hydatidosis. However, the combination of albendazole and praziquantel
seems to be more effective than albendazole alone in
reducing the risk of recurrence.2,
3 Treatment
is generally indi-cated for six months at the full dose, with regular
monitoring of blood levels of liver enzymes.2, 3 The Em18 antigen, IgG1, and IgG43 are commonly
used to monitor treatment response.
The patient is currently
continuing treat-ment and has shown remarkable clinical im-provement.
Conflict of interest
The authors have no conflict of
interest to declare.
REFERENCES
1. Durhan G, Tan AA, D|zg|n SA, Akkaya S, Arıy|rek OM. Radiological manifestations of thoracic hydatid cysts: pulmonary and extrapulmonary
findings. Insights Imaging. 2020;11:116.
https://doi.org/10.1186/s13244-020-00916-0
2. Velasco-Tirado V, Alonso-Sardsn M, Lopez-Bernus A, Romero-Alegrma A,
Burguillo FJ, Muro A, et al. Medical treatment of cystic: Systematic review and meta-analysis. BMC Infec Dis. 2018;18:306. https://doi.org/10.1186/s12879-018-3201-y
3. Morar R, Feldman C. Pulmonary echinococcosis.
Eur Resp J. 2003;21:1069-77. https://doi.org/10.1183/09031936.03.0 0108403
| GalerÃa de imágenes | ||
| Mujer joven con afectación pulmonar bilateral y alteración de la conciencia | ||
Autores: Churin Lisandro |
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