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Cystic Echinococcus Infection in a 10-Year-Old Iraqi Refugee

Weitzner, Jordan*; Bilhartz, Jacob*; Magliocca, Joseph; Freeman, Alvin Jay*

Journal of Pediatric Gastroenterology and Nutrition: October 2017 - Volume 65 - Issue 4 - p e94
doi: 10.1097/MPG.0000000000001064
Image of the Month

*Department of Pediatrics, Division of Pediatric Gastroenterology

Department of Surgery, Division of Transplantation, Emory University, Atlanta, GA.

Address correspondence and reprint requests to Jordan Weitzner, MD, Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA 30322 (e-mail:

Submissions for the Image of the Month should include high-quality TIF endoscopic images of unusual or informative findings. In addition, 1 or 2 other associated photographs, such as radiological or pathological images, can be submitted. A brief description of no more than 200 words should accompany the images. Submissions are to be made online at, and will undergo peer review by members of the NASPGHAN Endoscopy and Procedures Committee, as well as by the Journal.

The authors report no conflicts of interest.

A 10-year-old boy presented to the emergency department with 3 months of nonspecific abdominal pain. Five years prior, he had fled a refugee camp in Mosul, Iraq for the United States. An abdominal ultrasound revealed multiple fluid-filled sacs. Magnetic resonance imaging revealed 5 likely hydatid cysts in his liver, 3 involving his right lobe and 2 the left. Echinococcus immunoglobulin G was positive. The remainder of his investigation was unremarkable.

Albendazole was started for 4 weeks before surgery. He tolerated surgical resection well and maintained normal liver function. Albendazole will continue for 3 months, with aminotransferases and complete blood count monitored routinely. Follow-up magnetic resonance imaging will be obtained after 3 months (1,2).

Cystic Echinococcus is a very uncommon diagnosis in the United States. Treatment is guided by staging of the cysts, and options include medical therapy with bezimidazoles, interventional therapy with Puncture-Aspirate-Injection-Reaspiration, or surgical resection. The regions with the highest prevalence of Echinococcus include Asia Minor, the Middle East, and South Asia. As conflict in these areas continues, immigrants and refugees from these areas unknowingly infected with Echinococcus will seek treatment in American medical centers. Treatment requires a multidisciplinary approach at a center with expertise in caring for this disease (Figs. 1 and 2).





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1. Stojkovic M, Gottstein B, Junghanss T. Echinococcus. In: Farrar J et al eds. Manson's Tropical Diseases. 23rd ed. Saunders; 2013: 795–819.
2. Stojkovic M, Rosenberger K, Kauczor H-U, et al. Diagnosing and staging of cystic echinococcosis: how do CT and MRI perform in comparison to ultrasound? PLoS Negl Trop Dis 2012; 6:e1880.
© 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,