Primary Spinal Intradural Hydatid Cysts in a Child With Progressive Paraparesis: A Case Report and Literature Review

Primary spinal hydatid cyst is an uncommon form of echinococcosis, which may cause focal neurological deficits. We report an extremely rare case of spinal hydatic cyst with several diagnostic and therapeutic challenges. A 4-year-old boy was referred to our medical center suffering from progressive lower back pain, weakness and numbness in both lower limbs, and urinary incontinence for 4 months. He was initially misdiagnosed with rheumatoid arthritis (RA). However, as his clinical manifestations deteriorated, a neurosurgical consultation was requested to evaluate other differential diagnoses. Neurological examination revealed bilateral lower extremity weakness accompanied by increased deep tendon reflex (DTR) of the lower extremities. Thoracolumbar magnetic resonance imaging (MRI) demonstrated multicystic lesions, extramedullary intradural, extending from T8 to S2, which caused compression and posterior displacement of the cord. The patient underwent surgery and medical treatment with albendazole and praziquantel. Although early postoperative imaging showed no residual cysts, he experienced recurrence on follow-up. Due to the nonspecific manifestations and high morbidity of spinal hydatidosis, a multidisciplinary approach should be considered to diagnose and manage it. If spinal hydatid disease is diagnosed promptly, it can preclude severe complications, such as cyst expansion and subsequent spinal cord damage.