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Le Infezioni in Medicina, n.

1, 39-41, 2011

clinici Cystic hydatidosis: a rare case
of spine localization
reports Idatidosi cistica: localizzazione inusuale al rachide

Francesco Scarlata1, Salvatore Giordano2, Laura Saporito1,
Lorenzo Marasà3, Giuseppe Li Pani3, Antonio Odierna Contino4,
Vincenzo Scaglione4, Paola Di Carlo1, Amelia Romano2
Dipartimento di Scienze per la Promozione della Salute, Sezione di Malattie Infettive,
Università di Palermo, Palermo, Italy;
U.O. Malattie Infettive ARNAS Civico, Palermo, Italy;
U.O. Anatomia Patologica ARNAS Civico, Palermo, Italy;
U.O. Neurochirurgia ARNAS Civico, Palermo, Italy

n INTRODUCTION known as the PAIR procedure (ultrasonograph-
ic-guided puncture, aspiration of hydatid fluid,

ystic hydatidosis is the infection by larvae of injection of 95% ethanol, re-aspiration) and has
Echinococcus granulosus, a small tapeworm been used successfully at some centers [2].
which requires canines as definitive hosts We present a case of very rare localization of
and herbivores or humans as intermediate hosts. hydatid cysts in the dorsal spine.
Human infection is caused by ingestion of the
tapeworm eggs while playing with infected dogs
(which often present eggs in the fur) or through n CASE REPORT
consumption of garden vegetables or water con-
taminated by dog feces. G.C. was a 38-year old housewife admitted to
The disease is common in undeveloped areas of the Neurosurgery Department at the Civico
the Mediterranean basin, Middle East, Oceania, Hospital, Palermo, Italy, with lower limbs para-
South Africa and South America. Foci also exist plegia and urinary retention. The patient had
in regions of North America and South Europe. complained for lower limbs pain for 5 months.
In Italy the infection is endemic in the Southern Fever had appeared two weeks before admis-
regions and in the isles, mainly in Sardinia. sion. Her past medical history was remarkable
Liver and lungs are the most common sites of for pulmonary hydatid cyst disease surgically
cyst formation. Less frequently cyst develops in treated 25 years before. Six years before she was
the kidney, peritoneum, spleen. The involve- diagnosed with spinal hydatid cyst affecting
ment of other organs is very infrequent. the VIII thoracic vertebra for which only anal-
Cyst may be symptomless for 10 to 20 years un- gesic treatment was administered. On admis-
til it becomes large enough to produce symp- sion, the patient presented with flaccid paraple-
toms. If a cyst ruptures suddenly, a severe al- gia, bilateral loss of superficial sensation below
lergic reaction or even anaphylaxis and death the umbilical transversal line and spared deep
may occur. sensation. On abdomen examination, a full
The diagnosis is most often suspected when ra- bladder, resulting from over-distention, was
diographic examinations show space-occupy- noticed. Hematologic and chemical analyses
ing lesions of internal organs. Serological test- were within normal ranges. Serological testing
ing can be helpful despite variable sensitivity. to Echinococcus spp. by enzyme-linked im-
Surgical removal of cyst is the usual treatment. mune-sorbent assay (ELISA) showed high titers
Chemotherapy with albendazole is indicated of IgG and IgE specific antibodies.
for the treatment of patients with inoperable Computed tomography (CT) of the dorsal and
disease or as pre-surgical and post-surgical lumbar spine showed T8 vertebral body col-
treatment to reduce the risk of recurrence [1]. lapse and two osteolytic lesions involving T7.
Another intervention for inoperable cysts is Magnetic resonance imaging (MRI) further-


echinococcosis (Figure 2). The prognosis for hydatid disease of the Figure 1 . T8 and T9 vertebral bodies were excised and re. Cystic lesions invading the spinal canal with spinal cord compression. One week after. sacral (20%) and cervical spine (10%). Until now the patient is on ambulatory tensive physiotherapy. rate of recurrence is high [4]. 40 2011 . examination confirmed the diagnosis of 200x). T7. Differ- ently from other localizations where cyst en- larges radially. The patient was started on oral albendazole at the dose of 400 mg twice daily. Collapse spine remains poor. In fact surgical treatment of T8 vertebral body. Symptoms are not specific and are generally re- lated to spinal cord compression which tend to cause characteristic radicular syndromes of pain and segmental neurologic deficits. Figure 2 . charge. At discharge. neoplasm or cysts are similar). Ten days after.Cuticular membrane and isolated prolige- placed with titanium prostheses.Vertebral MRI. While plain radiographic findings are not specific (the images of tuberculosis. The disease occurs either by direct extension from pulmonary infestation or rarely begins primarily in vertebral body. in the bone the parasite grows multilocularly with dilatation of the spaces of spongiosa. she underwent T8 laminectomy. hydatid cysts causing spinal cord compression were removed. Hydatid cysts have inhomogeneous. The cyst breaks out of vertebral body anteriorly or laterally extending into ex- tradural spaces or paraspinal tissues and can extend into the spinal canal compressing the spinal cord [3]. low signal intensity on T1 weighted images and hyper intense signal on T2. Histological rous vesicles in the bone tissue (hematoxylin eosin.more demonstrated cystic lesions invading the spinal canal with spinal cord compression and morphologic alterations also of T9 vertebral body (Figure 1). was maintained until three months after dis- paresis which improved after a program of in. Thoracic CT revealed multiple nodules involv- ing both pulmonary apices and thickening of the left parietal and mediastinal pleura with mediastinal shift to the left side and mediasti- nal lymph node enlargement. osteolytic lesions involving T7 rarely extirpates completely the cysts. MRI is the gold standard for diagnos- ing hydatid disease of the spine. n DISCUSSION Hydatid disease of spine occurs in 1% of all cas- es of human echinococcosis and is most com- monly located in dorsal spine (50%) followed by lumbar (20%). Multiple. the patient presented mild para. There are no pathognomonic signs or symptoms. part- ly fissured. Then the and morphologic alterations of T9. Albendazole treatment follow up and no relapse had occurred.

164-169. Furthermore. Kerr R. [3] Rao S. 84-85. essere comunque sospettata anche in sedi non usuali. We Key words: Echinococcus granulosus. spine and heart. L’idatidosi è una malattia parassitaria a frequente stione pluridisciplinare che ha coinvolto infettivologi. 271. be suspected in the presence of lesions occupying zole and surgical intervention improved the clini. mentre le altre loca. in endemic areas hydatidosis must plegia of the legs. many cases of rare localizations of pected in presence of occupying space lesions echinococcosis remain undiagnosed or misdi. Relat. Johnson W. n REFERENCES [1] Ozdemir M.The reported case is remarkable for the rarity of tivity for echinococcosis or diagnostic imaging localization and for the absolute need of a mul.. Focus 17. neurochirurghi ed anatomopatologi. SUMMARY Cystic hydatidosis is a zoonosis endemic both to cal symptoms. è una zoonosi che costitui. Nel sospetto di ida- lizzazioni sono molto rare anche nelle aree endemiche. spinal hydatidosis in North America. Generally. Diker E. in presenza osservazione per paraplegia acuta degli arti inferiori. E8. Furthermore in en- was helpful for diagnosis. rochirurgico determinarono un miglioramento della sin- sce ancora oggi un importante problema sanitario in tomatologia.. RIASSUNTO L’echinococcosi. Pass H. Orthop. 41 2011 . We present a rare case of spinal Patients with suspected abdominal or lung hydatid disease. spinal think that patients with either serological posi. echinococcosis. In aree endemiche. This case is emblematic both for the Sicily and other Mediterranean areas. Chest 112. sia per l’importanza della ge- po. Medical treatment with albenda. è necessaria una valutazione Riportiamo il caso di una paziente di 38 anni affetta da più ampia per individuare eventuali localizzazioni cere- idatidosi del rachide dorsale che si presentava allo nostra brali. Il caso riportato è emblematico sia per la ra- numerosi Paesi sia industrializzati che in via di svilup. echinococcosis should also be investigated for oth- The patient was a 38-year-old housewife with a er localizations such as the brain. Res. The first level methods for other hydatid localiza- positive anamnesis for previous echinococcosis tions as brain. Heart 77. lung and less frequently in the peritoneum.D. cosis and successfully treated with albendazole. 2004. [4] Schnepper G. Echinococcal infestation Complete heart block caused by cardiac echinococ. Case report Nash T. o idatidosi... heart. Clin. Il di lesione occupante spazio l’eziologia echinococcica deve trattamento medico con albendazolo e l’intervento neu. spinali o cardiache. Neurosurg.D. Goksel S.. tidosi epatica o polmonare. 1991. spine. 1997. Recurrent [2] Mawhorter S. agnosed for many years with the dangers con- nected with the possible rupture of the cyst. unusual localization and for the need of a multi- Echinococcus granulosus tapeworms develop in the disciplinary approach for diagnosing and monitor- liver. cyst disease.. vertebral echinococcosis revealed by acute para. space in these districts. Temeck B. 1432-1436. spleen or kidney.. findings suggestive for abdominal or lung hy- tidisciplinary approach for diagnosing and datid cysts should be also investigated with monitoring of suspected hydatid lesions. demic areas hydatidosis must be always sus- Indeed.. localizzazione epatica e polmonare. 1997. Chang R. Parikh S. ing suspected hydatid lesions. of the spine in North America. Aydogdu S.. rità della localizzazione.. of these districts. Nonsurgical therapy for pulmonary hydatid and review of the literature.