Delayed presentation of pulmonary Echinococcus in a patient with no major risk factors

Abstract

A teacher in his 50s was referred urgently following an abnormal chest X-ray and a 4-week history of dark-green, blood-speckled productive cough, left-sided pleuritic pain, fevers, night sweats and unintentional weight loss with reduced appetite. He had received antibiotics from his general practitioner prior to referral. Born in the UK, he had no comorbidities, was an ex-smoker, had no recent foreign travel and reported no contact with animals. Examination showed reduced air entry at left lung base. Initial chest X-ray showed a left lower lobe cavitating lesion, with separate consolidation (figure 1a), concerning for pneumonia with underlying lung abscess or malignancy; however, blood results were not supportive of an inflammatory process. Sputum cultures were negative. CT scan showed a cavitating mass containing fluid, supportive of a lung abscess (figure 1d). Figure 1 Progression of the left lower lobe cavitating lesion on serial chest imaging. Chest X-ray at (a) initial presentation and (d) CT thorax at 2 weeks demonstrate a cavitating lesion with air-fluid level in the left lower lobe (yellow arrows). Follow-up imaging with chest X-ray at (b) 2 weeks and (c) 4 weeks, alongside interval …