Indian Journal of Medical Microbiology Medknow Publications on behalf of Indian Association of Medical Microbiology ISSN: 0255-0857 EISSN: 1998-3646 Vol. 29, Num. 2, 2011, pp. 192-193

Indian Journal of Medical Microbiology, Vol. 29, No. 2, April-June, 2011, pp. 192-193

Correspondence

Hydatid cyst in the spleen: A rare presentation

DV Patanvadia, YA Kruwala, S Lakhani, V Date, J Lakhani

Department of Microbiology, Smt. Bhikiben Kanjibhai Shah Medical Institute & Research Centre, At & PO-Piparia, District Vadodara - 391 760, India

Correspondence Address: D V Patanvadia Department of Microbiology, Smt. Bhikiben Kanjibhai Shah Medical Institute & Research Centre, At & PO-Piparia, District Vadodara - 391 760 India dr.dipak2008@gmail.com

Date of Submission: 20-May-2010
Date of Acceptance: 23-Mar-2011

Code Number: mb11046

PMID: 21654121

DOI: 10.4103/0255-0857.81778

Dear Editor,

A 35-year-old male patient was accidently detected to as having echinococcosis of the spleen. This was an atypical presentation of accidental splenic rupture, with hydatid cyst detected after laparotomy. The patient presented to the surgeon with blunt abdominal trauma due to a cow falling on him on 18 ^th February, 2010. The patient first went to a general practitioner who gave him primary treatment and also Inj.Diclofenac. He developed hypotension and was referred to the surgeon for further management. The provisional diagnosis was blunt abdominal trauma and anaphylactic reaction. Patient′s laparotomy was done after ultrasonography abdomen, with a diagnosis of splenic injury and large intraparenchymal haematoma and haemoperitoneum [Figure - 1]. Splenectomy was performed. A specimen of the spleen was sent to the laboratory. Anaphylaxis was due to the rupture of the cyst. The uniqueness of this case is the accidental detection of splenic hydatid cyst due to blunt abdominal trauma, which manifested in the form of anaphylactic reaction and shock due to fluid from the ruptured cyst, mistaken as an anaphylactic reaction to diclofenec.

Human echinococcosis is a zoonotic infection caused by the tapeworm of the genus Echinococcus. The primary hosts are the members of the Canidae family; usually dogs, wolves and coyotes. Our patient was a dog lover and he was not diagnosed earlier with hydatid disease. The intermediate hosts are the sheep, cattle and deer. Humans enter the cycle through infected canine faeces. The liver and the lungs are the most common sites of infection. ^[1] The splenic involvement represents less than 2-5% of all cases of human hydatid disease. Splenic involvement is possible by the arterial route once the parasite has passed through the liver and lung. The direct splenic involvement could occur through a retrograde venous route, which could be a possible route in our case, as the lung and liver were normal. ^[2]

Harefuah in 1992 described a 20-year-old soldier who presented with anaphylactic shock due to rupture of the splenic echinococcal cyst induced by blunt trauma to the left chest wall and upper abdomen. Surgery revealed an intact echinococcal cyst in the left lobe of the liver and another in the spleen. ^[3] But, in our case, the spleen was the only organ involved, which is the uniqueness of this case.

Until recently, the gold standard treatment for splenic hydatidosis was splenectomy. Medical therapy seems to be ineffective. However, the last two decades have shown a tendency towards splenic conservative surgery in suitable cases to reduce opportunistic post-splenectomy infection. ^[4] White pieces of cyst wall-like material were found in the ruptured spleen in our case. On gross examination, a brownish red mass of tissue with glistening white cyst wall-like material was seen [Figure - 2]. Direct impression smear showed Echinococcus scolices. For better contrast, a drop of Lugol′s iodine was added, which made the scolices more prominent. The images were captured using an Olympus Corporation-Shinjuku monolith, 3-1, nishi Shinjuku 2-chome, Shinjuku-ku, Tokyo, Japan [Figure - 3].

Splenic hydatid cyst is generally asymptomatic. The rarity of splenic hydatid disease may pose a diagnostic challenge for clinicians. Dissemination due to rupture of the cyst in the adjacent tissue is likely in this case. Standard treatment is partial or total splenectomy. Albendazole therapy is the mainstay of treatment in post-operative follow-up. ^[5] After the diagnosis of Echinococcus was made, the patient was treated with Tablet albendazole 400 mg twice a day for 28 days. The patient had a good recovery and uneventful course. The patient could survive this acute critical illness.

References

1.	Sehgal S, Mishra B, Thakur A, Dogra V, Loomba PS, Banerjee A. Hydatid cyst of Mediastinum. Indian J Med Microbiol 2008;26:80-1.  Back to cited text no. 1  [PUBMED]
2.	Singh H, Arora MS. Primary hydatid cyst of the spleen. Med J Armed Force India 2003;59:169-70.  Back to cited text no. 2
3.	Bitton M, Kleiner-Baumgarten A, Peiser J, Barki Y, Sukenik S. Anaphylactic shock after traumatic rupture of a splenic echinococcal cyst. Harefuah 1992;122:226-8  Back to cited text no. 3
4.	Bhandarwar AH, Katara AN, Bakhshi GD, Rathod MG, Quraishi AM. A review of literature- Splenic Hydatidosis. BHJ 2008;44:4.  Back to cited text no. 4
5.	Karabicak I, Yurtseven I, Yuruker SS, Ozen N, Kesim M. Splenic hydatid cyst. Can J Surg 2009;52:E209-10.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]

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