Long medical journey of a patient with hepatic echinococcosis: a case report

Hepatic echinococcosis is uncommon in Northeast China and often presents atypically, leading to misdiagnosis. We report a patient initially misdiagnosed with liver abscess whose prolonged and complicated course highlights the pitfalls in recognising this parasitic disease. A 48-year-old woman from Northeast China was referred after an 18-month odyssey of intermittent right-upper-quadrant pain repeatedly labelled "liver abscess". Multiple percutaneous drains, prolonged antibiotics and eventual sinus formation failed to control the lesion. Contrast CT at our centre raised the suspicion of metastases, whereas subsequent PET-CT favoured chronic infection but could not rule out abscess. However, percutaneous liver biopsy coupled with metagenomic sequencing identified Echinococcus multilocularis, and histopathology further confirmed necrotic granulomatous cysts consistent with a diagnosis of hepatic alveolar echinococcosis. She underwent radical hepatic resection in May 2024 followed by continuous albendazole. Post-operative imaging demonstrated complete removal, with no intra- or extra-hepatic relapse at 3-month follow-up, illustrating the importance of considering parasitic disease in indolent hepatic lesions.This case underscores the importance of including echinococcosis in the differential diagnosis of cystic hepatic lesions even in non-endemic areas of Northeast China. Early serological testing and characteristic imaging review can prevent unnecessary invasive procedures and guide definitive treatment.