Is Subcutaneous Seeding Possible Following PAIR Treatment of a Hydatid Cyst? A Case Report and Current Literature Review

Abs tractCystic echinococcosis (CE) is a widespread endemic helminthic disease caused by infection with the metacestodes of Echinococcus granulosus.This article reports the case of a 30-year-old woman who presented with a cystic lesion in the lumbar region.On the physical examination, cystic structures were palpated in the left gluteus maximus and posterior to the paravertebral muscles.Following a puncture, aspiration, injection, reaspiration (PAIR) procedure, an magnetic resonance imaging revealed a hyperintense cyst consistent with a newly developed CE1 hydatid cyst, likely resulting from subcutaneous seeding during the intervention.Various treatment modalities for hydatid disease have been described in the literature, including medical therapy, surgical approaches (laparoscopic, open, and robotic), and percutaneous techniques.In the majority of the articles, it has been indicated that PAIR treatment is associated with several risks and therefore should be recommended only for selected patients.This case demonstrates the effectiveness of PAIR therapy in reducing the number of daughter vesicles within hydatid cysts but also emphasizes the need for close follow-up due to the potential risk of new cyst formation caused by seeding during the procedure, particularly in atypical sites such as subcutaneous tissue.To the best of our knowledge, this is the first case described in the literature with this presentation.