Fever, eosinophilia and abdominal pain

We describe a case of liver hydatid cyst in a 34-year-old female who presented to hospital with a 4-day history of epigastric pain and fever. Her past medical history was unremarkable. She was born in Mumbai, India, and migrated to Australia in 2015. She did not have farm contact and/or wildlife exposures. Her white cell count was elevated 15.3×109/L, with a predominant eosinophilia 4.1×109/L, CRP 256 mg/L, AST 32 U/L, ALT 59 U/L, ALP 195 U/L and GGT 152 U/L. Echinococcus granulosis serology (EIA) was low positive. Abdominal ultrasonography and computed tomography showed a 13.3 cm liver lesion involving most of the left lobe of the liver with a surrounding hypodense thickened periphery, possibly with some haemorrhage. The patient was treated with albendazole 400 mg BD for 6 weeks before her elective laparotomy, deroofing of the hydatid cyst, removal of cyst contents, followed by cetrimide infusion into the cyst as a scolicidal agent. Echinococcus granulosis hooklets were seen on direct microscopy and trichome stain. Degenerated protoscolices were seen on histology. The patient was treated with 3 months of albendazole post-operation as the hydatid cyst involved all three hepatic veins and could not be completely resected. Her abdominal pain, eosinophilia and inflammatory markers improved post treatment.