1259 - Recurrent Spinal Hydatid Cyst Causing Paraplegia: A Case Report

Case Diagnosis: Spinal Hydatid Cyst

Case Description: This is an unusual case of recurrent primary hydatid cyst in spinal cord in a 16 year old female leading to paraplegia.She presented with weakness of lower limbs,bowel and bladder incontinence for four months.On examination had Spinal cord injury (SCI)at the level of T1.Contrast enhanced Magnetic Resonance Imaging revealed a lobulated cystic lesion of dimensions 4.5 ˣ 3.9 cm originating from posterior bony elements corresponding to D3-D4 level extending to right paravertebral space and spinal canal causing cord indentation.Excisional biopsy report was consistent with hydatid cyst treated surgically,followed by oral Albendazole for 3 months.After three months there was partial return of bladder and bowel function.However,lower limb weakness did not improve significantly.

Discussions:

Spinal hydatid cyst is usually asymptomatic as it can remain dormant,up to 40 years,with a recurrence rate of 30-40%.The patient presented in a similar fashion with complain of chronic upper back pain for 2 years followed by neurologic deficits.Serial MRI-scans could have been helpful to detect recurrence or serological testing after surgical treatment of 1st occurrence.She continued to live in an animal farm which could be a possible reason for the recurrence apart from the possibility of an incomplete excision of the cyst.Patient education about red flags associated with back ache,requiring urgent hospital visit play an important role in reducing complications and avoiding delayed presentation

Conclusions: Correct and timely diagnosis of hydatid cyst in spinal cord is challenging and often a diagnostic dilemma.In developing countries with a high prevalence of infectious diseases, possibility of spinal hydatidosis must be considered along with other infectious etiologies like tuberculosis and presence of benign or malignant conditions.Patient education on observing hygiene,early recognition and treatment is the key to reduce morbidity and risk of recurrence,thus a favorable prognosis in a rare cause of non-traumatic spinal cord injury.