A rare case of recurrent spinal hydatid cyst in a 17-year-old man with neurological deficits and balance impairment.

BACKGROUND

Hydatid cysts are caused by the larval stage of the tapeworm parasite Echinococcus granulosus, leading to a rare but significant zoonotic infection. This disease is primarily observed in regions with prevalent agricultural and livestock practices. While the liver, lungs, and brain are most affected, spinal involvement is notably rare. Hydatid cyst disease develops gradually and is usually asymptomatic in the early stages. Symptoms usually emerge when the cysts enlarge sufficiently to cause compression. Effective treatment typically combines surgical intervention with antiparasitic medication to reduce the risk of recurrence, highlighting the necessity of a comprehensive approach to treatment and follow-up.

CASE PRESENTATION

A 17-year-old male from Afghanistan, now residing in Iran, presented with muscle weakness in his lower extremities, primarily in the right leg, back pain, and impaired balance. The patient had a history of previous surgical resection for a primary spinal hydatidosis in Afghanistan. Upon examination, he exhibited reduced muscle strength, sensory loss in the right lower limb, paresthesia in the left medial forearm, hyperactive deep tendon reflexes in both legs and a positive Babinski sign on the right. Imaging revealed signs of previous laminectomy at T2 and T3 and a well-defined cystic mass at the T2 level. Surgical intervention was performed to decompress and resect the cyst, and pathological examination confirmed it as a hydatid cyst. Post-surgery, the patient was prescribed chewable albendazole (400 mg twice daily) for six months to prevent recurrence. Routine follow-ups and physiotherapy sessions were recommended after.

CONCLUSION

Patients with spinal hydatidosis often exhibit spinal cord compression symptoms. When imaging modalities reveal multiple cysts and there is a history of residency in an endemic area, spinal hydatid cyst should be considered. Although rare, spinal hydatid cysts are difficult to treat completely. This case highlights the critical need for precise surgical removal, adequate postoperative medication, and long-term follow-up in managing of spinal hydatid cysts.