A 17-year-old male with no relevant medical or epidemiological history was admitted for pain in the right hypochondrium, fever of 38.5°C and sudden onset of fever.
Analysis highlights leukocytosis (17,000/mm3) with 48.3% eosinophils, as well as alteration of the hepatic profile (total bilirubin 6 mg/dl, AST 113 IU/l, ALT 398 IU/l).
Abdominal ultrasound shows two space-occupying lesions: one of 7 x 5.5 cm in the VI-VII segments, rounded, hyperechogenic with central hypoechogenic areas and cystic fibrosis in the intrahepatic layer, 3 cm.
There is also marked dilation of the intrahepatic and extrahepatic bile ducts, with distal occupation of the choledochus duct by lineal hyperechogenic material without tape, compatible with the smallest hepatole with hydatid cyst.
The serology of hydatidosis was positive at very high titers (> 1/1024), so that bendazole at doses of 400 mg/12 hours is administered to broad-spectrum antibiotic coverage, with good clinical evolution.
A week later ERCP showed dilation of the intrahepatic and extrahepatic bile duct and multiple spindle-shaped images elongated in the hepatocholedochus duct.
Sphincterotomy and balloon pass with extraction of whitish germ membranes was performed and cholangiography with occlusion of the distal bile duct was performed without demonstrating the biliary tree between the cyst and the bile duct.
Subsequently, the patient underwent surgery without postoperative complications.
