Hepatic cystic echinococcosis in a low-endemic region, Denmark

Humans can become accidental, intermediate hosts of Echinococcus granulosus leading to cystic disease. We present a patient with liver cysts without obvious exposure to E. granulosus. His travel activity was limited, and country of residence had a low incidence with all cases assumed to be imported. The patient initially presented with acute severe abdominal pain, but also loss of appetite, fatigue and unintentional weight loss over a longer period of time. CT (computed tomography) scan revealed two cystic hepatic lesions. On suspicion of malignancy, liver biopsy was performed causing an anaphylactic reaction. Thorough diagnostics with serological analysis and histological findings the diagnosis cystic echinococcosis was revealed. The genotype was G1, E. granulosus sensu stricto (GenBank accession number: PX806355). The patient was commenced on albendazole and underwent a minimal invasive percutaneous procedure. Repeated CT images months later detected decreased size of the lesions without evidence of recurrence. This case highlights the importance of considering E. granulosus as a differential diagnosis in cystic liver lesions, even in patients without obvious exposure.