Abhinav Rajkumar¹, Philip N Britton^{2, 3}
 

¹ Department of Microbiology, The Prince of Wales Hospital

² Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead

³ Sydney ID, Sydney Medical School, University of Sydney

 

This case was an Australian-born 4-year-old child who had grown up on a rural farm who presented with 2 months’ of cough, shortness of breath, lethargy, reduced appetite and weight loss. On examination, body weight was below the normal range (< 1^st centile) and right-sided reduced breath sounds and pulmonary percussion dullness were noted. Chest imaging demonstrated diffuse right-sided opacification with two large cystic pulmonary lesions in the right hemithorax. Whilst being intubated and receiving positive pressure ventilation for planned lesion biopsy, a pulmonary cyst ruptured. Clinically, cyst rupture manifested with hypoxemia, bronchoconstriction, increased pulmonary ventilatory requirements and hypotension, indicative of an anaphylactoid reaction. Subsequently, the child required chest drain placement, drainage of cystic and pulmonary fluid, fluid resuscitation, vasopressor therapy including an adrenaline infusion, mechanical ventilation and admission to the intensive care unit. Microscopy of aspirated cystic fluid and bronchial fluid showed hooklets and protoscolices consistent with Echinococcus species. A diagnosis of pulmonary hydatid disease was made, and the child received albendazole[PB1]  andshowed clinical recovery with close ongoing monitoring. Hydatid serology performed retrospectively on serum tested negative. This case highlights the importance of early suspicion and diagnosis of pulmonary hydatid disease to direct appropriate management and minimise complications.