Recurrent pelvic osseous hydatid disease: a case report and review of management challenges

Background: Hydatid disease is a parasitic infection caused by Echinococcus species, most commonly affecting the liver and lungs. Skeletal involvement is rare, accounting for only 0.5%–4% of cases, with pelvic bone hydatidosis being exceptionally uncommon. Its indolent progression, nonspecific radiological features, and high recurrence rate make diagnosis and management particularly challenging. Case Presentation: We report the case of a 38-year-old male butcher from a rural region who presented with chronic left hip pain. Imaging studies revealed multiple cystic lesions involving the left iliac wing, sacrum, and pubic bone. A CT-guided biopsy confirmed osseous hydatid disease. The patient underwent surgical cystectomy followed by albendazole therapy. One year later, recurrence was detected on CT imaging, showing multiple cystic lesions in the left iliac crest without extra-pelvic involvement. The patient subsequently underwent image-guided injection of scolicidal solution and continued albendazole therapy. Discussion: Pelvic osseous hydatidosis poses diagnostic and therapeutic challenges due to its atypical presentation and complex regional anatomy. Radiological findings often mimic neoplastic or infectious conditions, leading to delayed diagnosis. Management requires a multidisciplinary approach involving surgical resection, adjunctive antiparasitic therapy, and vigilant long-term follow-up to prevent recurrence. Conclusion: This case highlights the recurrent nature of pelvic osseous hydatid disease and underscores the importance of early recognition, individualized surgical intervention, and prolonged medical therapy. Continuous monitoring remains crucial given the high propensity for relapses in skeletal hydatidosis.