Hepatic Invasive Echinococcosis Masquerading Angio-Invasive Hepatocellular Carcinoma — A Case Report

Hepatic invasive echinococcosis (HIE) also known as hepatic alveolar echinococcosis (HAE) is caused by the larval stage of Echinococcus multilocularis tapeworm. It’s transmitted through food or water contaminated with the eggs or through close contact with foxes or dogs. a case of 31 years old female presented with epigastric pain, nausea and vomiting from past several years. Abdominal imaging reveal multiple liver lesions which were biopsied. Histopathology of liver lesions showed chronic caseating granuloma, after which antituberculosis drugs was started. Her symptoms did not improved and on repeat imaging the size of the liver lesions had increased. On repeat biopsy of the liver lesions and lab workup, she was diagnosed with invasive echinococcosis. Albendazole 400mg BID was started. Her symptoms improved and the size of the lesions and cysts remained stable. She kept on regular follow ups with repeat abdominal imaging and lab workup. Hydatid cyst in the liver may be underdiagnosed and need careful evaluation with careful history, physical examination and appropriate imaging investigations.