Disseminated paediatric cystic echinococcosis with pulmonary, hepatic and renal involvement managed medically in a low-resource endemic setting

An early-adolescent girl from a hydatid-endemic region presented with 3 months of intermittent fever, cough with two episodes of haemoptysis, abdominal pain and fatigue. Examination was non-specific apart from right-upper-quadrant tenderness. Serology for Echinococcus granulosus was positive. Chest radiography and cross-sectional imaging demonstrated multiple hydatid cysts within both lungs, both hepatic lobes and the left kidney, with internal membranes and the pathognomonic ‘serpent sign’ in one pulmonary cyst. Given multiplicity and distribution across three organs, percutaneous drainage and surgery were deferred. Albendazole (approximately 15 mg/kg/day in two divided doses) was administered for 12 weeks with clinical improvement and planned radiological surveillance. This case illustrates the diagnostic approach to disseminated cystic echinococcosis in children, rational selection of non-operative management when operative risk is high and the public health implications for clinicians practising in non-endemic settings who care for migrant and travelling populations.