Postpartum maternal death resulting from complications of a large hydatid cyst of the lung in a resource-constraint setting: A rare case report and review of literature

Cystic echinococcosis (CE), a parasitic zoonotic infection caused by the larval stage of Echinococcus granulosus, predominantly affects the liver and lungs but can occur in any organ or tissue. Hydatid cysts during pregnancy are rare, with an incidence of approximately 1 in 20,000-30,000 pregnancies, and are often associated with more severe symptoms due to the physiological changes of pregnancy. In endemic areas, early recognition and prompt management are critical to improving outcomes. This case report from Northern Tanzania highlights a 30-year-old pregnant woman at 30 weeks of gestation who presented with respiratory distress, cough, fever, and chest pain. Imaging studies, including contrast-enhanced computed tomography (CT) of the chest, identified a large complex cystic lesion occupying the right hemithorax, consistent with a pulmonary hydatid cyst. Serological testing supported the diagnosis of CE. Following interdisciplinary team deliberation, labor was induced at 30 weeks, she delivered a healthy baby but subsequently developed postpartum hemorrhage, which required an emergency total abdominal hysterectomy due to uterine atony. Despite aggressive management, the patient developed severe respiratory complications and succumbed 10 days later in the surgical intensive care unit. This case underscores the challenges of diagnosing and managing CE in pregnancy, particularly in resource-limited settings.