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Lack of efficacy and left intracerebral haemorrhage: case report A woman in her 60s exhibited lack of efficacy during treatment with albendazole and praziquantel for hydatid disease (Echinococcosis). Additionally, she developed left intracerebral haemorrhage during treatment with heparin and aspirin for deep venous thrombosis prophylaxis [routes not stated; not all dosages stated]. The woman, who had been diagnosed with hydatid disease (Echinococcosis) in early 1960s, underwent a femoral head excision with good results. In 1975, she had recurrence of disease. Over the next 13 years, she had multiple excisions and aspirations of cysts on the left pelvis, femur and surrounding soft tissue. During this time, her physician prescribed her intermittent course of mebendazole. In 1988, she was started on long term albendazole at 400mg twice daily in a 4 week on and 2 week off cycle. A CT scan showed that she had became stable for a time with lessening of pain and stable disease. In 2004, she was referred back to the infectious disease clinic with increasing pain and spontaneous discharge from the left hip. Therefore, she was started on praziquantel 600mg thrice daily on the first day of each albendazole cycle. In late 2006, she presented for worsening hip pain. An MRI showed a new multiloculated cysts in the right rectus abdominis muscle and lateral to the left iliac wing, together with almost complete replacement of the left hemipelvis with disease. The diseases was progressing while receiving albendazole and praziquantel therapy (lack of efficacy). Hip cyst was aspirated, which resulted in symptomatic relief. Thereafter, the woman developed a secondary group G streptococcal infection in her chronic hip sinus and was treated with ceftriaxone followed by long-term treatment with amoxicillin. Thereafter, she was started on an off-label treatment with nitazoxanide 500mg twice daily along with albendazole 400mg twice daily. The nitazoxanide was continued for 3 months, following which she was on albendazole only. She tolerated this treatment well. Following the course of nitazoxanide, an imaging demonstrated a significant regression of the soft tissue cysts in the abdominal wall and lateral to the left iliac wing with stable bony disease. She was reviewed in the clinic and reported lessening of hip pain and swelling. An examination revealed persisting sinus over the left hip with the diminished discharge. Therefore, an additional course of nitazoxanide for 1 month was given. After completion of the second course of nitazoxanide, she was hospitalised for septic shock possibly due to a secondary bacterial infection of the hip sinus. She had been receiving aspirin and heparin for the prophylaxis of deep venous thrombosis. Initially, she responded well to the treatment; however, on day-5 of hospitalisation, she developed massive left intracerebral haemorrhage secondary to heparin and aspirin [durations of treatments to reaction onset not stated] and eventually died of it. She did not have a history of cerebrovascular disease,