Pitfalls in diagnosis and treatment of alveolar echinococcosis: a sentinel case series
Background Alveolar echinococcosis (AE) is a neglected zoonosis presenting with focal liver lesions (FLL) with a wide range of imaging patterns resembling benign as well as malignant FLLs. Complementary serology and histopathology may be misleading. - Objective The objective of our study is to highl...
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| Main Authors: | , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
December 31, 2015
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| In: |
BMJ open gastroenterology
Year: 2015, Volume: 2, Issue: 1 |
| ISSN: | 2054-4774 |
| DOI: | 10.1136/bmjgast-2015-000036 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1136/bmjgast-2015-000036 Verlag, lizenzpflichtig, Volltext: https://bmjopengastro.bmj.com/content/2/1/e000036 
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| Author Notes: | M. Stojkovic, C. Mickan, TF Weber, T. Junghanss |
| Summary: | Background Alveolar echinococcosis (AE) is a neglected zoonosis presenting with focal liver lesions (FLL) with a wide range of imaging patterns resembling benign as well as malignant FLLs. Complementary serology and histopathology may be misleading. - Objective The objective of our study is to highlight pitfalls leading to wrong diagnoses and harmful interventions in patients with AE. - Design This retrospective sentinel case series analyses diagnostic and treatment data of patients with confirmed AE. - Results 80 patients treated between 1999 and 2014 were included in the study. In 26/80 patients treatment decisions were based on a wrong diagnosis. AE was mistaken for cystic echinococcosis (CE) in 12/26 patients followed by cholangiocellular carcinoma (CCA) in 5/26 patients; 61/80 patients had predominantly infiltrative liver lesions and 19/80 patients had a predominantly pseudocystic radiological presentation. Serology correctly differentiated between Echinococcus multilocularis and Echinococcus granulosus in 53/80 patients. Histopathology reports attributed the right Echinococcus species in 25/58 patients but failed to differentiate E. multilocularis from E. granulosus in 25/58 patients. Although contraindicated in AE 8/25 patients treated surgically had instillation of a protoscolicidal agent intraoperatively. One of the eight patients developed toxic cholangitis and liver failure and died 1 year after liver transplantation. - Conclusions Misclassification of AE leads to a critical delay in growth inhibiting benzimidazole treatment, surgical overtreatment and bares the risk of liver failure if protoscolicidal agents are instilled in AE pseudocysts. |
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| Item Description: | Gesehen am 23.06.2020 |
| Physical Description: | Online Resource |
| ISSN: | 2054-4774 |
| DOI: | 10.1136/bmjgast-2015-000036 |