Pulmonary hydatidosis presenting as pyopneumothorax in a 15 year old male

Gaurang Aurangabadkar,Ulhas Jadhav,Saood Ali,Ajay Lanjewar

doi:10.18231/j.pjms.2021.071

Gaurang Aurangabadkar, Ulhas Jadhav + Show 2 more

Open Access

https://doi.org/10.18231/j.pjms.2021.071

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Abstract

Pulmonary hydatid cyst is an exceptional cause of pyopneumothorax that should be considered in countries where hydatid disease is endemic. The documented rates of simple pneumothorax in patients with pulmonary hydatidosis ranges from 2.4-6.2%. Hydatidosis is a parasitic zoonosis of the genus Echinococcus that infects herbivores and humans in its larvae stage(hydatid) and in paediatric population, generally presents as pulmonary hydatidosis. Misdiagnosis of this condition as tubercular in origin can cause treatment and prognostic delays for the patient. We report a case of a 15 year old male presenting with complaints of breathlessness (Grade 2 MMRC) since 3 months and dry cough, low grade fever with chills since 3 months. He had previously received AKT therapy and IV antibiotics. His blood investigations were normal. His sputum for AFB, CBNAAT was negative. His initial chest xray was suggestive of right sided hydropneumothorax. CECT Thorax revealed features suggestive of hydatid cyst in right posterobasal segment lower lobe with loculated pyopneumothorax with collapsed and consolidated right lung with mediastinal lymphadenopathy. After admission, Intercostal chest drainage tube was inserted on the right side and connected to underwater seal and pleural fluid was drained. Pleural fluid investigations revealed exudative effusion by Lights criteria, ADA was 150, culture and sensitivity revealed no growth and cytology revealed features of empyema.The patient was started on IV Piperacillin+Tazobactam, IV Metronidazole and Tab Albendazole for 14 days along with AKT considering raised pleural fluid ADA levels as suggestive of tubercular pleural effusion. The patients hydatid serology (Echinococcus IgG Antibody ELISA- 0.88) came out to be positive which confirmed our diagnosis of hydatidosis. After repeat chest x ray, there was resolution noted in effusion and ICD tube was removed and the patient was discharged on oral antibiotics for 14 days and Tab Albendazole for 3 months.

Highlights

Pulmonary hydatid cyst is a rare cause of pneumothorax with the incidence of simple pneumothorax in the paediatric population as a result of pulmonary hydatidosis is around 2.4 to 6.2% of the patients
Due to the presence of chest xray findings, it has the potential of being misdiagnosed as a case of tubercular pleural effusion or empyema
His blood investigations were normal and pleural fluid analysis revealed exudative effusion by Lights criteria, pleural fluid ADA levels were 150 and culture/sensitivity revealed no growth, pleural fluid cytology revealed empyema like nature of effusion with pleural fluid TLC/DLC suggestive of lymphocytic effusion, pleural fluid AFB and CBNAAT were negative for mycobacterium tuberculosis

Summary

Introduction

Pulmonary hydatid cyst is a rare cause of pneumothorax with the incidence of simple pneumothorax in the paediatric population as a result of pulmonary hydatidosis is around 2.4 to 6.2% of the patients. Due to the presence of chest xray findings, it has the potential of being misdiagnosed as a case of tubercular pleural effusion or empyema. Hydatid cyst (PHC) may rupture into the pleural cavity or bronchus. In such cases, PHC may be misdiagnosed with other common pulmonary diseases like tuberculosis and patients may not be receiving appropriate treatment. Misdiagnoses of PHC may even lead to major lung resection or pneumonectomy

Case History

On Respiratory examination

Provisional diagnosis

Findings

Discussion

Conclusion