The first case of alveolar echinococcosis from southern Croatia: progressive course of the disease in an immunocompromised patient

Introduction: Alveolar echinococcosis is one of the most pathogenic zoonoses caused by the larval forms of Echinococcus multilocularis. It is endemic in central Europe, but from 2001 to 2018, eight European countries reported their first cases of alveolar echinococcosis. These numbers testify to unprecedented spread of the infection.

Case report: We report the first case of alveolar echinococcosis from southern Croatia that was incidentally found in an immunocompromised 70-year-old male patient. He was admitted to the hospital due to macrohematuria and renal insufficiency. Diagnostic assessment of kidney impairment revealed a large liver infiltration whose radiographic appearance was suspicious of a cancer. Nevertheless, histopathological and molecular analysis of the liver biopsy confirmed alveolar echinococcosis. The lesion was irresectable due to expansion along the major liver vessels. Therefore, conservative treatment with albendazole was started and the existing immunosuppressive therapy was modulated. The control imaging following 11 months of albendazole treatment showed regression of the lesions.

Conclusions: It is not clear whether this case was imported or autochthonous, but it is evident that the incidence of alveolar echinococcosis is rising in Europe. Due to its rareness and malignant nature of the disease, it is often misdiagnosed or diagnosed late when radical surgical treatment is impossible to perform. Clinicians should be aware of this emerging parasitic disease, especially in immunocompromised patients, because every delay in reaching the diagnosis seriously hampers therapeutic efficacy. Better therapeutic options and standardized guidelines on the modulation of immunosuppressive therapy in these patients are highly needed.