Hepatobiliary alveolar echinococcosis treated with delayed resection following percutaneous drainage

Alveolar echinococcosis is an uncommon and potentially life-threatening disease caused by the parasite Echinococcus multilocularis. Although incidence has been increasing, it continues to be an overlooked infectious disease in North America. In this case, the patient presented with jaundice, cholestatic hepatitis, and 14 kg weight loss over two months. He was subsequently diagnosed with metastatic alveolar echinococcosis affecting the spleen, biliary tract, and liver. Due to the extensive nature of his disease, he was initially considered unsuitable for curative resection. The patient was assessed for liver transplantation by a multidisciplinary team including Hepatobiliary/ Transplant Surgery, Transplant Hepatology, Transplant Infectious Diseases, and an Infectious Diseases physician experienced in managing alveolar echinococcosis. The patient and team opted for medical management given the high perioperative morbidity and substantial risk of disease recurrence. After percutaneous drain placement and 2.5 years of albendazole monotherapy, significant regression of the disease permitted curative intent left hepatectomy with en-bloc cholecystectomy. The surgery was completed successfully and the patient continues albendazole therapy following evidence of residual disease on PET-CT. This case illustrates the challenges inherent in the management of advanced alveolar echinococcosis, reviews decision-making regarding transplantation, and underscores the importance of a multidisciplinary approach to disease management.