Acute peritoneal propagation of alveolar echinococcosis in a 12-year-old child.

Herein we present a case of a 12-year-old child with acute symptoms (abdominal pain, fever). Preliminary imaging suggested pyogenic liver abscess. Despite the broad-spectrum antibiotic therapy, which was started after hospital admission, no improvement was perceived. Rising eosinophilia and multiplex focal lesions detected by ultrasound and MRI forced serological investigation by which Echinococcus granulosus s.l. seropositivity was detected. Antihelminthic therapy was initiated and upon multidisciplinary consultation surgical intervention was performed with the removal of a cystic lesion which ruptured to the peritoneal cavity. Histopathological and parasitological analysis finally verified alveolar echinococcosis (AE) caused by Echinococcus multilocularis. As the evacuation of one lesion cannot be regarded as curative intervention in this form of echinococcosis, albendazole was administered continuously until patient's medical condition improved and no progression was detected during imaging follow-up. In Hungary both cystic and alveolar echinococcosis are present therefore differential diagnosis of these two forms can be a clinical challenge. Slow rate of progression, long lasting asymptomatic period and relatively low incidence of AE disease can explain that cases during childhood are rarely identified. After reviewing all relevant literature in this topic, we present here the first pediatric AE case in Hungary.