Primary Gluteal Hydatid Cyst: A Case Report

Introduction and background: Hydatid disease (HD) is a parasitic infection caused by the larval form of Echinococcus granulosus. It is endemic in regions with widespread livestock farming and close human-animal contact. Although the liver and lungs are the most frequently involved organs, rare cases of primary subcutaneous hydatid cysts have been reported, especially in the absence of visceral involvement. Gluteal localization is extremely rare and may be misdiagnosed due to its nonspecific presentation. Case presentation: We report the case of a 25-year-old woman who presented with a gradually enlarging, painless swelling over the lateral aspect of her right buttock, noted over five months. There were no systemic symptoms, and she had no history of trauma or prior medical conditions. Physical examination revealed a well-circumscribed, fluctuating, non-mobile mass measuring 5 × 4 cm with no overlying skin changes. Laboratory results were within normal limits. Ultrasound imaging revealed multiple well-defined cystic lesions in the subcutaneous tissue. Chest X-ray and abdominal ultrasound excluded hepatic or pulmonary hydatidosis. A diagnosis of primary subcutaneous hydatid cyst was made. The patient underwent pericystectomy under spinal anesthesia. Intraoperatively, typical hydatid features were noted, and the cyst cavity was thoroughly irrigated with hypertonic saline. Postoperatively, Albendazole therapy (400 mg twice daily) was administered for three months. There were no signs of recurrence during 6 months of follow-up. Discussion: Primary soft tissue hydatid cysts are rare and can mimic benign soft tissue tumors or abscesses. In endemic regions, such lesions should be carefully evaluated using imaging and clinical suspicion. The diagnosis is typically made through imaging, and definitive treatment includes surgical excision with careful handling to prevent dissemination, accompanied by pre- and postoperative anthelmintic therapy to minimize recurrence. Conclusion: This case highlights the importance of considering hydatid disease in the differential diagnosis of gluteal masses, especially in endemic areas. Prompt diagnosis and combined surgical and pharmacologic therapy can lead to excellent outcomes without recurrence.