Recurrent Femoral Osseous Hydatid Disease Managed With Repeated Intramedullary Curettage: A Case Report.

Hydatid disease is a parasitic infection primarily caused by Echinococcus granulosus. Osseous hydatid disease is an uncommon manifestation and may present significant diagnostic and therapeutic challenges because of its insidious progression and tumor-like appearance. Femoral involvement is particularly rare. We report the case of a 44-year-old hypertensive woman who presented with chronic mechanical pain of the right hip evolving since 2019 and initially treated as lumbosciatica without improvement. MRI revealed an extensive intramedullary osteolytic lesion involving the right femoral diaphysis over 25 cm, initially suggestive of a bone tumor. Histopathological examination following femoral biopsy confirmed intraosseous hydatid disease. The patient underwent intramedullary curettage, reaming, and scolicidal irrigation associated with prolonged albendazole therapy. Despite initial treatment, MRI follow-up demonstrated local recurrence requiring revision surgery with repeated intramedullary debridement and irrigation using hydrogen peroxide and hypertonic saline. At more than six months of follow-up after revision surgery, the patient remained pain-free with preserved limb function and no pathological fracture. This case highlights the diagnostic difficulties, high recurrence potential, and therapeutic challenges of femoral osseous hydatidosis. In endemic regions, hydatid disease should be considered in the differential diagnosis of chronic osteolytic lesions of long bones.