Recurrent multiple-organ involvement of disseminated alveolar echinococcosis in 3 patients

RATIONALE Alveolar echinococcosis (AE) is a rare but highly malignant form of echinococcosis caused by Echinococcus multilocularis. There have been very few reports on multiple-organ AE, especially AE in bones. Here we report 3 rare cases of disseminated multiple-organ AE from western China and its neighboring areas. PATIENT CONCERNS Patient 1 had back and left hip pain, headache, and weakness in left lower limb, often with minor epilepsy and fluctuation of blood pressure. Lower limbs Babinski sign was positive and muscular tension was above normal range. The second patient had pain in lower limbs and chest discomfort without fever, cough, sputum, chest tightness, or hemoptysis. Patient 3 had masses and pain in the back side of his right shoulder. DIAGNOSES The patients had been treated for AE multiple times and were positive for serum hydatid antigens. They were diagnosed as multiorgan AE involving liver, spinal cord, and many other organs. INTERVENTIONS The patients had undergone surgeries to decompress the spinal cord, remove lesions from tissues as required, and were put on albendazole for at least 2 years. OUTCOMES The patients responded well and AE recurrence has not occurred. LESSONS All 3 cases experienced multiple recurrences of AE due to missed diagnosis, misdiagnosis, or inappropriate treatment, which resulted in metastatic multiorgan AE. These cases demonstrated the need for more policy attention to battle AE endemic in western China.