(1532) An Unexpected Finding During an Elective Hiatal Hernia Repair

Introduction: Echinococcosis is a serious and potentially life-threatening parasitic disease caused by larval forms of Echinococcus tapeworms. This zoonotic infection can occur in patients who are exposed to definitive and intermediate hosts such as dogs, sheep, goats, and swine. Contamination of water and soil by infected animals are potential routes of transmission. While there are few cases in the literature describing Echinococcosis in solid organ transplant recipients, there is some evidence to suggest an increased incidence in the immunocompromised host. In this case report we present the unexpected finding of an echinococcal infection in an asymptomatic lung transplant recipient.

Description: This is the case of a 59-year-old male farmer from Montana who underwent a bilateral lung transplant in Phoenix, AZ for idiopathic pulmonary fibrosis (IPF). One year after his transplant, he underwent an elective hiatal hernia repair for the treatment of severe gastroesophageal reflux disease (GERD). During laparoscopic examination, the caudate lobe of the liver was noted to have multiple firm, white, cystic appearing lesions. Frozen section revealed cystic spaces with a hydatid cyst wall. The cysts contained protoscolices. The microscopic appearance suggested the presence of daughter cysts. Post operative serology was obtained and interestingly, Echinococcus Antibody IgG was normal. The patient was asymptomatic prior to surgery. He was immediately initiated on albendazole and after 5 months of therapy, CT scan demonstrated an absence of cystic lesions within the liver.

Discussion: This case highlights the challenge of diagnosing a potentially life-threatening parasitic infection in an asymptomatic transplant patient. In addition, it demonstrates the importance of utilizing clinical, radiographic, and histologic findings when serologic testing is normal. As transplant centers expand their outreach to patients across the country, a careful evaluation of exposure history can be essential in accurately diagnosing diseases which are non-endemic to their region.