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An 11-year-old Romanian girl in the UK presented with malaise, nausea and a productive cough. The examination found reduced air entry in the left lung base. C reactive protein was 214 mg/dL with neutrophilia (18 × 10⁹/L) and eosinophilia (1.8 × 10⁹/L). Chest X-ray and CT revealed a complex cystic lesion in the left lower lobe with bronchial communication and surrounding collapse and consolidation (figures 1 and 2). Tuberculosis was excluded by negative Quantiferon Gold, sputum PCR and Mantoux. Imaging suggested cystic echinococcosis (CE), confirmed by positive ELISA and Western blot for Echinococcus granulosus. The presentation was likely due to cyst rupture.