Fatal alveolar echinococcosis of the lumbar spine

Abstract

For the last 10 years, the southern part of Belgium has been recognized as a low-risk area of endemicity for alveolar echinococcosis. This infection, caused by Echinococcus multilocularis, usually induces a severe liver condition and can sometimes spread to other organs. However, alveolar echinococcosis involving bones has been described only very rarely. Here, a fatal case of spondylodiscitis due to E. multilocularis contracted in southern Belgium is reported.

Fig 1

Chest CT shows multiple well-marginated, roundish nodules with a perivascular distribution (panels A and B, white arrows) and some solid nodules with an internal cavity due to the erosion of the distal bronchioli by the nodules (panel B, white arrowhead).

Fig 2

Sagittal and axial reformatted CT images of the lumbar spine with a massive active bone osteolysis of the posterior arches of L4 and L5 (panels A and B, white arrows) and of the vertebral body of L4 (panel A, asterisk).

Fig 3

The histopathological examination of the paravertebral lesion shows a fibrous capsule characterized by the presence of a PAS-positive laminated layer, typical of the metacestode stage of E. multilocularis (PAS staining; original magnification, ×4).