a man with disabling low back pain echinococcus of the sacrum

Medical ImageryKeywords: Echinococcus hydatid Boneinvolvement in hydatiddisease is rare, and when itdoesoccur, themost commonsites of involvementarethespineandpelvis.Acaseofbonehydatiddi

Medical Imagery

Keywords:

Echinococcus

hydatid

Boneinvolvement in hydatiddisease is rare, and when itdoesoccur, themost commonsites of involvementarethespineandpelvis.Acaseofbonehydatiddiseaseinvolvingthesacrumisreported here

ß2016TheAuthor(s).PublishedbyElsevierLtdonbehalfofInternationalSocietyforInfectiousDiseases ThisisanopenaccessarticleundertheCCBY-NC-NDlicense(

http://creativecommons.org/licenses/by-nc-nd/4.0/)

ContentslistsavailableatScienceDirect

j o urn a l hom e pa ge : ww w e l s e v i e r c om/ l o ca t e / i j i d

http://dx.doi.org/10.1016/j.ijid.2016.06.001

1 Introduction

Echinococcosis(alsocommonlyreferredtoashydatiddisease

orhydatidosis)isaparasiticinfectionthatisstillcommoninmany

partsoftheworld.Regionsendemicfortheinfectionincludesome

areasofAfrica,Europe,Asia,theMiddleEast,andCentralandSouth

America.1,2

Boneinvolvementisarareoccurrence(0.5–4%),andtypically

presentsasmultiloculatedcystsinthevertebralbody,withdisk

spacesparing.Spinal involvementisseen in30–50%andpelvic

involvementin20%ofthesecases.3,4

2 Casereport

A61-year-oldmalepresented totheemergencydepartment

withpersistentandseverelowbackpain.Thepatientalsohada

history of low backpain in thepast 6 months Hereported a

previousdiagnosisofmultiplerenalstonesandwasscheduledfora

percutaneousnephrostomywithinthenext2weeks

Oninitialevaluationthepatientwasafebrilewithstablevital

signs.Nocostovertebralangletendernesswaspresent.Therewere

no radicular symptoms or focal neurological findings Midline

tendernesswasdetectedinthelowerlumbarandsacralarea

Anabdomino-pelviccomputedtomography(CT)scanshowed

multiplerenalstonesinbothkidneys(notshown).Therewasalso

anexpansilelyticlesionwithareasofcorticaldisruptionin the

sacralbone.Afewbonytrabeculaewereseenwithinthelesion

(Figure1 Thelocationofthelesioncorrelatedwiththepointof

maximum tendernesson physical examination Magnetic

reso-nanceimaging(MRI)wasorderedtoevaluatetheextensionofthe

lesionandsoft tissueinvolvement TheMRIresultsrevealedan

expansilelesionwithhighsignalintensityinT2-weightedimages andlowsignalintensityinT1-weightedimages(Figure2

Thepatientunderwentsurgicalresection,withapresumptive diagnosis of a possible malignancy However, the pathological examinationrevealedthatthelesionwasahydatidcyst

3 Discussion This case represents an example of a patient who had not received a complete diagnostic workup The patient’s initial symptomswereattributedtonephrolithiasisafterthedetection

ofrenalstonesintheabdominalradiographs.Boneinvolvementin hydatiddiseaseisarareoccurrence,5andwhenitdoesoccur,its most common locations are the spine and pelvis.6 Vertebral diseaseusuallymanifestsasamulticysticlesionthatgrowsina branchingpatternalongthelinesofleastresistanceinbone.7Soft tissueinvolvementisusuallymoreprominent.5Theradiographic findingsinthiscasewereunexpected,astherewasauniloculated lyticlesion,withminimalsofttissueextension

Inareaswherehydatiddiseaseisendemic,bonyinvolvement fromechinococcosiscanbeconsideredinthedifferentialdiagnosis

ofosteolyticlesions

Acknowledgement ThisresearchwassupportedfinanciallybytheChancellorfor Research of MashhadUniversity of Medical Sciences,Mashhad, Iran.Wethankthepatientforgivinguswrittenconsenttopublish thecase

Conflictofinterest:Noconflictofinteresttodeclare

1990;19:435–9.

233–8.

BitaAbbasi RezaAkhavan FarrokhSeilanianToosi SirousNekooei*

FacultyofMedicine,MashhadUniversityofMedicalSciences,

Mashhad,Iran

*Correspondingauthor.Tel.:+985138416314;

fax:+985138416314 E-mailaddress:dr.abbasib@gmail.com(S.Nekooei)