Bouikhif Manal, Farhane Sana, Lyagoubi Mohamed, Aoufi Sarra
Laboratoire central de parasitologie et mycologie, Centre hospitalier universitaire Ibn Sina, Rabat, Maroc.
Faculté de médecine et de pharmacie, Université Mohamed V, Rabat, Maroc.
Med Trop Sante Int. 2022 Jul 18;2(3). doi: 10.48327/mtsi.v2i3.2022.195. eCollection 2022 Sep 30.
Hydatidosis is a zoonosis caused by . It's a real public health problem in Morocco. Muscle localization is unusual, even in endemic countries. We report a rarely described case of a hydatid cyst of the psoas muscle diagnosed in our laboratory.
The patient was a 32-year-old male, living in a rural area. He reported a contact with dogs. He was admitted in vascular surgery department for left hypochondrium pain, with heaviness of the left lower limb and appearance of varicose veins. Clinical examination has found a huge painful and hard mass of the left flank arriving to the hypogastrium with varicose veins of the left leg. An injected CT scan of the pelvic region showed a 189 x 137 mm cystic mass of the left psoas muscle reflowing left iliac vessels. This suggested hydatid cyst. No other localization was found. Hydatid serology was positive with an ELISA test and an indirect hemagglutination test. The patient underwent surgery to remove the mass. Several white vesicles of a few centimeters were found in the cyst and were sent to the parasitology laboratory. Microscopic examination has confirmed the presence of viable . The patient received albendazole 400 mg twice daily for only a month and was not seen for follow-up. One year after surgery, he showed the same symptoms of abdominal pain and heaviness. Recurrence of hydatid cysts in the same localization was diagnosed with ultrasound showing two hydatid cysts type 3 according to Gharbi classification.
Diagnosis of all hydatidosis localizations is based on epidemiological, clinical, and radiological data and confirmed by serology and parasitological examination of the surgical specimen. Surgery is then a diagnostic and therapeutic tool that cannot be bypassed since it allows the definitive elimination of the parasite and eviction of recurrence if it's well done. Conservative methods are related to recurrent cysts.
Muscle hydatidosis is extremely rare but should not be forgotten when radiological and epidemiological data suggest it. It's a benign infection but can be severe and deadly if not appropriately treated.
包虫病是一种由……引起的人畜共患病。在摩洛哥，它是一个实实在在的公共卫生问题。肌肉部位受累情况并不常见，即便在流行国家也是如此。我们报告了在我们实验室诊断出的一例罕见的腰大肌包虫囊肿病例。
患者为一名32岁男性，居住在农村地区。他自述与狗有过接触。因左季肋部疼痛、左下肢沉重及出现静脉曲张而入住血管外科。临床检查发现左腰部有一个巨大的疼痛性硬块，延伸至下腹部，并伴有左腿静脉曲张。盆腔区域增强CT扫描显示左腰大肌有一个189×137毫米的囊性肿块，压迫左髂血管。这提示为包虫囊肿。未发现其他部位受累。酶联免疫吸附试验（ELISA）和间接血凝试验显示包虫血清学呈阳性。患者接受了手术以切除肿块。在囊肿内发现了几个几厘米长的白色囊泡，并送去寄生虫学实验室检查。显微镜检查证实存在活的……。患者仅接受了一个月的阿苯达唑治疗，每日两次，每次400毫克，之后未进行随访。术后一年，他出现了相同的腹痛和沉重症状。超声检查诊断为同一部位包虫囊肿复发，根据加尔比分类法显示为两个3型包虫囊肿。
所有部位包虫病的诊断均基于流行病学、临床和放射学数据，并通过手术标本的血清学和寄生虫学检查得以证实。手术是一种不可或缺的诊断和治疗手段，因为如果操作得当，它能彻底清除寄生虫并避免复发。保守治疗方法适用于复发性囊肿。
肌肉包虫病极为罕见，但当放射学和流行病学数据提示时，不应被忽视。它是一种良性感染，但如果治疗不当可能会很严重甚至致命。
