Pitfalls in diagnosis and treatment of alveolar echinococcosis

• Verfasst von: Stojković, Marija [VerfasserIn]
• Verfasst von: Mickan, Christina [VerfasserIn]
• Verfasst von: Weber, Tim [VerfasserIn]
• Verfasst von: Junghanss, Thomas [VerfasserIn]
• Titel: Pitfalls in diagnosis and treatment of alveolar echinococcosis
• Titelzusatz: a sentinel case series
• Verf.angabe: M. Stojkovic, C. Mickan, TF Weber, T. Junghanss
• E-Jahr: 2015
• Jahr: December 31, 2015
• Fussnoten: Gesehen am 23.06.2020
• Titel Quelle: Enthalten in: BMJ open gastroenterology
• Ort Quelle: London : BMJ Publishing Group, 2014
• Jahr Quelle: 2015
• Band/Heft Quelle: 2(2015,1) Artikel-Nummer e000036, 6 Seiten
• ISSN Quelle: 2054-4774
• DOI: doi:10.1136/bmjgast-2015-000036
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: HEPATOBILIARY PATHOLOGY
• Sach-SW: HEPATOBILIARY RADIOLOGY
• Sach-SW: INFECTIOUS DISEASE
• K10plus-PPN: 1701983087

Abstract

Background Alveolar echinococcosis (AE) is a neglected zoonosis presenting with focal liver lesions (FLL) with a wide range of imaging patterns resembling benign as well as malignant FLLs. Complementary serology and histopathology may be misleading. - Objective The objective of our study is to highlight pitfalls leading to wrong diagnoses and harmful interventions in patients with AE. - Design This retrospective sentinel case series analyses diagnostic and treatment data of patients with confirmed AE. - Results 80 patients treated between 1999 and 2014 were included in the study. In 26/80 patients treatment decisions were based on a wrong diagnosis. AE was mistaken for cystic echinococcosis (CE) in 12/26 patients followed by cholangiocellular carcinoma (CCA) in 5/26 patients; 61/80 patients had predominantly infiltrative liver lesions and 19/80 patients had a predominantly pseudocystic radiological presentation. Serology correctly differentiated between Echinococcus multilocularis and Echinococcus granulosus in 53/80 patients. Histopathology reports attributed the right Echinococcus species in 25/58 patients but failed to differentiate E. multilocularis from E. granulosus in 25/58 patients. Although contraindicated in AE 8/25 patients treated surgically had instillation of a protoscolicidal agent intraoperatively. One of the eight patients developed toxic cholangitis and liver failure and died 1 year after liver transplantation. - Conclusions Misclassification of AE leads to a critical delay in growth inhibiting benzimidazole treatment, surgical overtreatment and bares the risk of liver failure if protoscolicidal agents are instilled in AE pseudocysts.