Concomitant splenic and hepatic hydatid cysts in a patient with previous pulmonary echinococcosis: a case report

Background: Cystic echinococcosis (CE) is caused by Echinococcus granulosus sensu lato, whereas Echinococcus multilocularis causes alveolar echinococcosis. CE predominantly affects the liver and lungs; splenic involvement is uncommon, particularly with concomitant hepatic disease. Case presentation: A 40-year-old man with a history of pulmonary hydatid cyst surgery 1 year earlier presented with abdominal heaviness or fullness, early satiety, and dyspepsia. Examination revealed left upper-quadrant fullness with a palpable non-pulsatile mass. Computed tomography demonstrated a single giant splenic cyst and two hepatic cystic lesions in segments IV and VIII, consistent with hydatid disease. Laboratory tests showed leukocytosis (16 200/mm 3 ; neutrophils 94%), anemia (hemoglobin 8.4 g/dL), and mild thrombocytopenia (136 × 10 3 /mm 3 ). He underwent open surgery because of the large splenic cyst and dense adhesions. The operative field was isolated with hypertonic-saline-soaked gauze; total splenectomy was performed, and the hepatic cysts underwent cystotomy, evacuation, and drainage. The cyst contained turbid fluid and daughter cysts, consistent with hydatid disease. A sample of cyst fluid was sent for microbiological analysis, with no bacterial growth documented. The postoperative course was uneventful. He received albendazole 400 mg twice daily for 3 months and remained clinically well at 3-month follow-up. Discussion: This case illustrates sequential multi-organ CE involving the lung, spleen, and liver. Giant splenic cysts with extensive parenchymal replacement may require total splenectomy with meticulous anti-spillage precautions and adjunctive antiparasitic therapy. Conclusion: Individualized surgical management can achieve favorable early outcomes in multi-organ CE, although long-term imaging surveillance remains necessary.