Medical treatment for an isolated renal multilocular hydatid cyst in an elderly: a case report
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CASE REPORT
Open Access
Medical treatment for an isolated renal multilocular hydatid cyst in an elderly: a case report Atie Moghtadaie1, Seyed Amir Miratashi Yazdi2, Minoo Mohraz3, Hoda Asefi4 and Effat Razeghi4,5,6*
Abstract Background: Almost all cases of renal hydatid cysts need surgical intervention for treatment. We report a case of isolated renal hydatid cyst treated successfully only with medical therapy. Case presentation: This case is a 79-year-old veterinarian presented with right flank pain, hydatiduria and positive echinococcus granulosus serology. A 70*50 mm cyst with daughter cysts in mid-portion of right kidney on presentation was changed into a 60*40 mm cyst without daughter cysts at last follow-up. Due to patient’s refusal of surgery, our patient received medical treatment including praziquantel and albendazole. After completion of first round of treatment, recurrence occurred and the same treatment was repeated. At last, the cyst became inactive and calcified with negative serology and no clinical symptoms under medical treatment. Conclusion: The treatment of choice in renal hydatid cyst is surgery; although there are some reports about the efficacy of medical treatments for hydatid cysts but lower rates of recurrence and higher efficacy put surgery in a superior position compared to medical approaches. Our case showed relative success of medical treatment, despite the presence of a large multilocular renal involvement. Thus, medical therapy without surgery can be considered in very particular cases with isolated renal hydatid cysts. Keywords: Case report, Hydatid cyst, Medical treatment, Renal mass
Background Hydatid cysts are caused by echinococcus species. Echinococcus is a flat worm with three evolutionary stages during its life cycle. The structure of this cyst is usually composed of three components. A component is a “pericyst” which is produced by the inflammatory tissues of the host. The other two elements are “exocysts” and “endocysts” [1, 2]. Iran is an endemic region for hydatid disease. The prevalence of hydatid cysts in Iran has been reported to vary from 1.2 to 13.8% in different parts of the country [3]. * Correspondence: [email protected] 4 Sina hospital, Tehran University of Medical Sciences, Tehran, Iran 5 Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran Full list of author information is available at the end of the article
Risk factors of development of hydatid cysts include direct contact with animals such as sheep and dogs, as well as geographic region and consumption of contaminated water and raw vegetables. This infection can affect different organs of the body. The most common involved parts of the body are liver (~ 50–70% of cases) and lung [4]. Involvements of spleen, brain and kidney are also reported in the literature. Isolated renal involvement is very rare and accounts for about 2% of the all cases [5]. Renal involvement in hydatid cysts can be symptomatic or asymptomatic. The diagnosis is based on history, imaging, pathological
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