Department of Internal Medicine, Sonnenhofspital, Bern, Switzerland.
Institute of Parasitology, University of Bern, Bern, Switzerland.
Lancet Infect Dis. 2018 Mar;18(3):e87-e98. doi: 10.1016/S1473-3099(17)30335-3. Epub 2017 Aug 11.
Alveolar echinococcosis caused by Echinococcus multilocularis is an infrequent zoonosis with a high degree of disability, morbidity, and mortality, especially in disease clusters of the northern hemisphere. The diagnosis is complicated by extended incubation time, diverse clinical manifestations, and mimicking of differential diagnoses. The primary organ affected is the liver, but extrahepatic disease is possible, with vertebral involvement in only a few dozen cases described worldwide. Although vertebral alveolar echinococcosis seems to be rare, it might be under diagnosed, and it might be seen more often as the number of people with immunocompromised conditions increases. Recognition of this syndrome is crucial, because advances in medical and surgical management strategies since the introduction of benzimidazole in 1976 have controlled and relieved symptoms in most cases. In this Grand Round, we present the case of a 75-year-old woman who was referred for biopsy of a lumbar lesion 3 months after she was diagnosed with chronic myeloid leukaemia. The diagnosis of hepatic alveolar echinococcosis with metastasis to the lumbar spine and paravertebral region as well as the brain was confirmed by biopsy, PCR, and serology. The patient was given albendazole and referred for palliative surgery with the aim of pain control. Clinical features of the case are presented and discussed in the context of the literature. This case and review illustrate the complexity of extrahepatic alveolar echinococcosis manifestations and the necessity of an interdisciplinary approach.
泡型包虫病由多房棘球绦虫引起，是一种罕见的动物源性传染病，具有高度致残性、发病率和死亡率，尤其在北半球疾病聚集区。该病潜伏期长，临床表现多样，且与其他疾病的鉴别诊断相似，诊断较为复杂。主要受累器官是肝脏，但也可能发生肝外疾病，全世界仅有几十例描述了累及脊柱的病例。虽然椎体泡型包虫病似乎很少见，但由于免疫功能低下人群的数量增加，可能被低估，也可能更常见。认识到这种综合征至关重要，因为自 1976 年苯并咪唑问世以来，医学和手术管理策略的进步已在大多数情况下控制和缓解了症状。在本次大查房中，我们介绍了一位 75 岁女性的病例，她在被诊断为慢性髓性白血病 3 个月后因腰椎病变而被转来进行活检。通过活检、PCR 和血清学检查确诊为肝泡型包虫病伴腰椎和椎旁转移及脑部转移。给予阿苯达唑治疗，并转介姑息性手术以控制疼痛。结合文献对该病例的临床特征进行了讨论。本病例和综述说明了肝外泡型包虫病表现的复杂性，以及需要采取多学科方法的必要性。
