J Korean Med Sci.  2025 Feb;40(4):e88. 10.3346/jkms.2025.40.e88.

Delayed Diagnosis of Imported Cystic Echinococcosis and Successful Treatment With Percutaneous Drainage and Albendazole in Korea: A Case Report

• Choi WJ
• Jin H
• Jo HJ
• Lee CM
• Kang CK
• Choe PG
• Park WB
• Kim NJ
• Choi MH

• KMID: 2564235
• DOI: http://doi.org/10.3346/jkms.2025.40.e88

Abstract

Echinococcosis, caused by the tapeworm Echinococcus, is rare in Korea and is primarily imported from endemic areas. We report a case of a 37-year-old Korean man with multiple large hepatic cysts, initially diagnosed as simple cysts at a local clinic in 2018. The patient had lived in Oman, an endemic area, for several months in 2016. Upon referral to a tertiary hospital in 2023, due to progressive cyst enlargement, liver magnetic resonance imaging revealed three large cysts with a water lily sign. Serum IgG against Echinococcus was positive by enzyme-linked immunosorbent assay. After diagnosis of echinococcosis, treatment with albendazole and puncture-aspiration-injection-reaspiration (PAIR) was performed. Microscopic and molecular analysis of cyst aspirates confirmed Echinococcus granulosus infection. Follow-up computed tomography demonstrated a reduction in cyst size, yet the emergence of a new right pleural effusion and consolidation in the left lower lobe of the lung necessitated the continuation of albendazole therapy. This case highlights the importance of thorough travel history, imaging findings, and the effectiveness of PAIR combined with albendazole in treating imported echinococcosis.

Keyword

Albendazole; Echinococcosis; Magnetic Resonance Imaging; Percutaneous Aspiration-Injection-Reaspiration; Republic of Korea

Figure

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  Fig. 1 Timeline of disease progression and treatment.CT = computed tomography, SNUH = Seoul National University Hospital, MRI = magnetic resonance imaging, PAIR = puncture-aspiration-injection-reaspiration, F/U = follow-up.

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  Fig. 2 Hepatic cysts in the liver in 2023. (A) Liver magnetic resonance showing three cystic lesions (arrows) in the right lobe of the liver. (B) Cyst-within-cyst sign within the largest cyst (an arrow), suggesting a hydatid cyst.

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  Fig. 3 Cystogram during PAIR and gross appearance & microscopic findings of cyst aspirate. (A) Cystogram during a PAIR procedure for the largest hepatic cyst. (B) Gross finding of aspirated cyst fluid. (C, D) Protoscoleces of E. granulosus on microscopic examination.PAIR = puncture-aspiration-injection-reaspiration.

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  Fig. 4 CT findings before and after PAIR. (A) Abdominal CT showing the largest cyst before PAIR (an arrow). (B) Abdominal CT showing a reduction in cyst size after PAIR (an arrow). (C) A small amount of pleural effusion (an arrow) observed after PAIR. (D) Focal consolidation (an arrow) in the left lower lobe of the lung observed after PAIR.CT = computed tomography, PAIR = puncture-aspiration-injection-reaspiration.

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