Rare presentations of hydatid cyst disease

To the Editor, I read the latest case report of Wei et al with great interest which published in your journal in June, 2022. Authors reported an interesting hydatid cyst case which mimicked malignant cancer. Interestingly, hydatid cyst really mimics other clinical conditions. I would like to present other unusual and rare presentations of the hydatid cyst disease along with a short expression of general information about the infection. Hydatid cyst disease is caused by Echinococcus granulosus infection and usually present with cysts in internal organs. Most of the cysts appear in liver and lung in hydatid cyst disease. However, cysts can be seen in other organs, such as spleen and heart. After accidentally ingestion of parasite, acidity of upper gastrointestinal tract cause opening of Echinococcus granulosus eggs. Released larvae of the parasite penetrate the bowel wall and pass into portal circulation. When they cross out portal filter, every organ could be potentially reached by the parasite. Parasitic infection may cause hydatid cysts in liver, lungs, spleen, and other rare localizations. Hydatid cyst disease is commonly asymptomatic. It may be diagnosed incidentally on imaging studies. It may present with symptoms caused by an enlarging or superinfected cyst. Otherwise, signs and symptoms of hydatic cyst disease are usually nonspecific and generally based on the localization of the cysts. Signs and symptoms include but not limited to abdominal pain, chest pain, biliary obstruction, cholangitis, portal hypertension, cirrhosis, bronchial obstruction, and abscesses. Uncommon clinical presentations may also be seen in infected patients. For instance, large hepatic cyst which compresses renal artery may cause secondary hypertension. The disease may also present with pulmonary hypertension, infective endocarditis, and abdominal compartment syndrome. Rarely, presentation with anaphylactic shock due to the rupture of the cysts may occur. In another case report authors stated that a hydatid cyst with 12 1.5 cm dimensions was revealed in bladder neck which caused pollakiuria symptom in the patient. In another interesting case, authors reported pancreatic hydatid cyst in a patient presented with abdominal pain and jaundice. Therefore, the disease can mimic a number of clinical conditions. In Wei et al's study, the disease mimicked renal cell carcinoma. Indeed, alike with cancers, hydatid cyst is also associated increased inflammatory burden. In conclusion, hydatid cyst due to Echinococcus granulosus infection may present with a wide range of signs and symptoms. Physicians should have high degree of suspicion in sake of early diagnosis of the disease.