Recurrent Vertebro-Medullary Hydatidosis Presenting 18 Years After Initial Treatment: A Case Report and Review of Diagnostic Challenges

Abstract Introduction Vertebro-medullary hydatidosis (VMH) is a rare manifestation of hydatid disease, even in endemic regions including the eastern Mediterranean, North Africa, Central Asia, southern and eastern Europe, South America, Siberia, and western China. VMH is associated with substantial morbidity because of delayed diagnosis, spinal cord compression, and frequent relapse. Recurrence after prolonged symptom-free intervals remains uncommon. Case Description A 56-year-old man with a history of VMH treated in 2007 presented in 2025 with progressive spinal cord compression syndrome. Computed tomography and magnetic resonance imaging (MRI) revealed a multiloculated cystic lesion involving the T10–T11 vertebrae with spinal canal extension and spinal cord compression. Surgical excision and spinal osteosynthesis were performed. Histopathological examination demonstrated characteristic laminated membranes and rare scolices, confirming recurrent VMH. The patient improved postoperatively and received prolonged albendazole therapy. Discussion This case highlights the rarity of VMH, the diagnostic challenge posed by its nonspecific clinical presentation, and the potential for relapse after an exceptionally long 18-year disease-free interval. Recurrent VMH should remain in the differential diagnosis of patients with a history of spinal hydatid disease presenting with new neurological symptoms. Long-term clinical and MRI surveillance is warranted to facilitate early detection and timely management of delayed relapse.