[Anaphylactic shock caused by rupture of an echinococcal cyst in a 25-year-old asylum seeker from Georgia].

HISTORY AND ADMISSION FINDINGS: A 25-year-old asylum seeker from Georgia was admitted to hospital with acute right upper quadrant abdominal pain, vertigo, dyspnea, generalized urticaria and positive shock index (blood pressure 80/40 mmHg, pulse 120/min) several minutes after eating an instant soup.

INVESTIGATIONS: Laboratory investigations showed a slight increase of the eosinophilic cell count and GOT and GPT activities. Abdominal ultrasound scan (USS) and computed tomography (CT) revealed a multivesicular septated cystic space-occupying lesion of the right liver lobe (segment VII, 13 x 9 x 8 cm) and perihepatic fluid.

TREATMENT AND COURSE: Intravenous steroids, H 1 and H 2 antagonists and fluid were given. Emergency laparatomy with endocystectomy was performed. A 3-month course of antihelmintic therapy with albendazole was applied. During follow-up up to one year after surgery the patient did well. Ultrasonography and computed tomography showed only a small residual defect in the right liver lobe where the cyst had been removed.

CONCLUSION

In patients from echinococcosis-endemic regions who develop an anaphylactic reaction, a ruptured Echinococcus granulosus cyst should be considered in the differential diagnosis. Abdominal ultrasonography and serology (to be noted: substantial rate of false negative results!) should be performed.