Rare case of Hydatid cyst of foot: a report

Dr Biniam Ewnte at Djibouti Medical Center, Debre Tabor, Ethiopia and colleagues have reported a rare case of hydatid cyst of the foot. The case has appeared in the Journal of Medical Case Reports.

Hydatid disease is due to infection by the tapeworm Echinococcus granulosus in its larval or cyst stage. Hydatid cyst is rarely located in soft tissues. This case of a hydatid cyst over the plantar surface of patient's foot as in this case is one of the rarest presentations. Detection of the typical germinal membrane can guide the diagnosis of hydatid cyst in rare locations that are found incidentally.

A 22-year-old Somali presented to the surgical referral clinic of Djibouti Medical Center (a private hospital located in Hargeisa, Republic of Somaliland) in March 2019 with the main complaint of progressive swelling associated with pain over the left plantar side of his foot. He had no abdominal pain or discomfort, no chest pain or cough. He noticed the swelling 1 year prior to the presentation. There was no history of trauma to the site, no difficulties of walking, no discharge from the swelling, and no lesions noticed on other sites.

He is a college student who lives with his parents; he had no prior medical problems. He has two brothers and a sister. There are no medical illnesses that run in the family. There was no history of tobacco smoking or substance abuse. He has never consumed alcohol.

At presentation, his blood pressure was 120/70 mmHg, pulse rate was 74 beats per minute (bpm), respiratory rate was 18 per minute, and the temperature was 36.0 °C axillary. A physical examination of our patient was normal in the rest of his systems. He also had a normal neurological finding. The pertinent finding was an oval-shaped, 2.5 cm wide in diameter, well-circumscribed lump with no increased vascularity, which was non-pulsatile and located over the mid-plantar area of his left foot. It was minimally tender to touch, fluctuant, and with no color change of the overlying skin.

A complete blood count of our patient showed: white blood cells (WBC) 5000 mcL, red blood cells (RBC) 4.7 mcL, hemoglobin (Hgb) 15 gm/dL, hematocrit (Hct) 45%, mean corpuscular volume (MCV) 83, platelets 370 × 10³, creatinine 0.7, blood urea nitrogen (BUN) 17, alanine aminotransferase (ALT) 30, aspartate aminotransferase (AST) 28, alkaline phosphatase (ALP) 58, albumin 4.5, total bilirubin 1.2, and direct bilirubin 0.3.

No radiological scan or blood culture was done for the patient. With the initial impression of callus; he was prepared for a minor surgical operation to remove the mass.

After cleaning the area of the lump was infiltrated with local anaesthesia: lidocaine without adrenaline was used. A transverse incision was made over the lump, followed by dissection of the subcutaneous tissue. Upon exposing the subcutaneous tissue, a typical endocyst membrane covering the hydatid cyst was encountered (Fig. 1).

courtesy Journal of Medical Case Reports

Further dissection revealed the pericyst and endocyst very clearly (Fig. 2). Protecting the surrounding area with iodine-soaked gauze, the endocytic membrane was aspirated, revealing a sandy content.

Courtesy Journal of Medical Case Reports

Following surgery, he was sent home with diclofenac 50 mg twice a day for 5 days. Follow-up was done a week later, the wound looked ok. The stitches were removed on the tenth postoperative day. Albendazole 400 mg per day was given for 2 weeks' duration. Subsequently, an ultrasound of his liver to look for possible primary cysts was done and it did not show any focus of a cyst.

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Hydatid cyst of the foot: a case report