A 59-year-old woman with no past history of interest was admitted for pain in the right epigastrium-hypochondrium radiating to the scapula together with jaundice and food intolerance of 5 days' evolution. On examination he had a heart rate of 80 bpm, afebrile (36.3º), with jaundice of the skin and mucous membranes and on palpation the abdomen was soft, depressible and non-painful. The ED blood test showed a total bilirubin of 11.63 mainly due to direct bilirubin (7.12), amylase of 135, GPT 221, LDH 557, leukocytosis of 14,400 and eosinophilia of 5,480 (normal value: 0-0.8). An abdominal ultrasound was performed, which revealed a well-defined cystic lesion measuring 6.9 x 6 cm in the right hepatic lobe, compatible with a hydatid cyst, together with multiple biliary lithiasis. Bladder, pancreatic body, kidneys, spleen and bladder were normal. No free peritoneal fluid. In view of the findings, the patient was started on albendazole treatment. After one day of admission the patient presented an episode of anaphylactic shock with dyspnoea and desaturation (pO2 50 mmHg, SatO2 86.9), fever (38º), bilateral wheezing, erythematous skin lesions and eosinophilia. The emergency abdominal CT scan showed no new data with respect to the ultrasound and after administering 80 mg i.v. of urbason and 1 i.v. ampoule of Polaramine®, she underwent emergency surgery for anaphylaxis with the following findings: partially calcified hydatid cyst in segment V-VII and VIII, intimately adhered to the diaphragm. Intraoperative ultrasound showed a cyst in contact with the inferior vena cava and right suprahepatic vein. The patient underwent puncture, aspiration and sterilisation with hypertonic saline in addition to cholecystectomy and choledochotomy. After clinical and analytical improvement after 15 days, the patient was discharged on treatment with albendazole.

