Hydatid Disease of Tibia Reconstructed with Allograft: A Rare Case Report and Literature Review

Abstract

Background: Hydatid disease of bone shows a well-defined, multiloculated lytic lesion with the appearance of a bunch of grapes. The presenting symptoms are pain and swelling with or without pathological fracture. The treatment options include surgery followed by a long duration of albendazole. Removal of the involved bone is required to decrease the chances of recurrences.

Case report: In our study, we have included a case of 28-year-old woman presented with complaints of pain and difficulty in weight bearing over her right lower limb for 2.5 months. Radiograph suggested an eccentric lytic lesion in midshaft of tibia and biopsy revealed granulosus cyst wall, nucleate germinal layer, the brood capsule, and protoscolices with visible hooklets. Patient was subjected to surgery with the excision of cyst along with extended curettage of bone creating a bone defect around the lesion and with anterolateral platting with coverage of bone defect by allogenic bone grafting. Patient was kept on above knee slab with non-weight-bearing mobilization for 6 weeks. Postoperative chemotherapy with Albendazole was given for 3 months. Patient was followed up every 6 weeks for 3 months and every month thereafter on outpatient basis. Return to work and patient satisfaction were excellent.

Conclusion: Definitive Surgical management with Preoperative and postoperative chemotherapy seems to be effective to avoid recurrence. The bone defect caused by the disease or surgery can be managed with a bone graft either of autograft or allograft.

Keywords: Allogenic bone graft; echinococcosis; hydatid cyst; skeletal hydatosis; tibia.

Figure 1

(A) Preoperative image, right leg with scar mark of biopsy and mild swelling. (B) Preoperative X-ray showing expansile lytic lesion in mid shaft tibia. (C) Intraoperative images, excised hydatid cyst mass. (D) Immediate postoperative X-ray showing in corporation of allograft and fixation by anterolateral tibial plate. (E) Post operative X-ray at 6 month follow up showing well incorporation of allograft. (F–H) Clinical images at 6 month follow up showing healed scar mark no swelling or deformity and full weight bearing of the patient with full return to activity of daily living

Figure 2

Hematoxylin and eosin (H&E ×40) stained section shows E. Granulosus cyst wall (A) acellular laminated layer; (B) a nucleate germinal layer; (C) the brood capsule (red arrow), protoscolices (green arrow) with visible hooklets (D)