Immunosuppression Does Not Appear to Affect Echinococcal Cyst Viability as Confirmed by Immunoblotting Test: A Case Report in a Lung Transplant Patient

ABSTRACT. A 61-year-old Italian woman was diagnosed with a CE4 echinococcal cyst in the seventh hepatic segment. The cyst was managed conservatively (“watch and wait”) as per WHO guidelines. Serology for Echinococcus granulosus (ELISA) was negative. Five years later, in September 2025, the patient underwent bilateral lung transplant for chronic obstructive pulmonary disease. Induction with basiliximab, steroids, and treatment with tacrolimus and mycophenolic acid was started. Serology for E. granulosus (ELISA, rapid test [RT], and immunoblotting [IB]) remained negative, and the patient was managed expectantly. Serology with ELISA, RT, and IB remained negative at 0, 1, 3, and 6 months posttransplant. The cyst remained unchanged at all time points. Although anecdotal, this finding supports the hypothesis that unlike alveolar echinococcosis, immunosuppression has no effect on the viability of E. granulosus cysts. This has important clinical consequences. The American Society of Transplantation suggests treating patients for cystic echinococcosis before transplantation, and for adequate candidates, it recommends surgical removal with perioperative albendazole, an approach not supported by the literature. The need for treatment or surgical management of cystic echinococcosis in immunocompromised patients should be reconsidered.