A 54-year-old woman, housewife, from Longaví (Region of Maule, Chile), with no known morbid history.
She had been suffering from malaise, fever and right hip pain for three months.
He did not report having had contact with domestic animals, consumed well-cooked foods and had access to drinking water for four years.
He decided to consult in another center two months before being hospitalized and in his tests highlighted hematocrit: 36%, hemoglobin: 11.4 g/dl: leukocytes: 5,700/mm3, (eosinophiles 5%) and leukocytes:
He underwent upper endoscopy and protein electrophoresis with normal findings.
Abdominal ultrasound showed colitis.
The patient was treated with cloxacillin and antiparasitic drugs without steroidal response.
Two weeks prior to admission, the patient experienced an increase in symptoms, with the addition of erythema and an increase in local temperature in the right thigh, with a fever peak up to 39°C in the axillary region.
The patient was admitted to the Department of Medicine with stable hemodynamics and fever.
The segmental physical examination revealed erythema in the right glue, with sensitive induration and pain on passive and active mobilization of the right hip.
On admission, hematocrit was 31.8%, hemoglobin 10.4 g/dl, leukocytes 9900/mm3 (neutrophils 62%, eosinophils 6%), ESR 67 mg/h and CRP 12.3 mg/dl.
Liver function tests, blood glucose, plasma electrolytes, coagulation tests and platelet count were normal.
An infectious picture of blade tissues with probable joint involvement of the right hip was raised and ev antibiotic therapy with cefazolin and clindamycin was started.
Blood cultures obtained at admission were negative.
Magnetic resonance imaging (MRI) of the right retroperitoneal complex collection of approximately 13 cm in maximum diameter with multiple septa inside, hypointense walls, extending superficially to the triangle of the lumbar tissues was requested.
In addition, right middle glue myositis.
It was decided to complement with computed tomography (CT) which confirmed the existence of a large retroperitoneal abscess extending to the subcutaneous cellular tissue of the right lumbar region.
A gastrointestinal origin of the lesion was not demonstrated in imaging studies.
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It was then decided to perform percutaneous drainage of the abscess under tomographic vision installing two pigtail catheters ; the previous day antimicrobials were suspended and approximately 180 ce of purulent fluid or weight was extracted.
Samples were taken for aerobic and anaerobic cultures, Gram direct staining K negative and Ziehl Neelsen, Koch culture, staining for Actinomyces sp, all of which were suspended.
Samples of aspirated fluid were also sent for analysis by pathology.
Antibiotic therapy with ceftriaxone and clin-damycin ev was resumed.
Laboratory tests revealed anemia (Hto 28%), white blood cell count of 6,200/mm3, increased sensitivity 9%, and decreased CRP to 3 mg/dL.
The tomographic control showed a decrease in the size of the retroperitoneal collection and the fluid obtained from the drainage was increasingly scarce, with a seropurulent appearance to be the changeographic appearance.
The pathology report described macroscopically three fragments of a whitish yellowish and translucent material of l.5 to 2.6 cm in diameter greater than 0.1 cm in thickness.
Microscopic examination revealed fragments of structures with multi-organization, tapering and loose bands, associated with various calcifying bodies, some ganchiter-like and polimorphous leukocyte-like structures.
No evidence of neoplasia was found in the sections examined.
The sample was studied with current histological technique, serial sections at various levels, histochemical techniques and Gomori-Gro and Ziehl-Neelsen stains.
The morphological aspect and histochemical tests were compatible with fragments of viable QH cuticle.
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The diagnosis was confirmed by ELISA IgG positive for E. granulo (examination performed in the institutional laboratory).
Antibiotic therapy was then changed to moxifloxacin 400 mg/day v.o. and albendazole 800 mg/day v.o. and the presence of hydatid cysts in other organs was actively sought (Q).
The surgical team decided not to perform a surgical intervention given the location of the lesion.
Medical treatment and imaging control were planned on an outpatient basis and possible subsequent surgical resolution.
A CT scan of the abdomen and two weeks after hospital discharge showed a decrease in size of the retroperitoneal pelvis and right glue region.
It was decided to maintain albendazole 800 mg/day for 12 weeks and not perform surgical intervention.
The patient experienced a progressive decrease in her symptoms and normalization of inflammatory parameters.
Ten months later, a CT scan showed a decrease in residual stenosis size.
The patient continues to follow-up with good evolution to the date of sending this manuscript (usually asymptomatic in controls annual CT scan), unrecognizable in CT studies.
