Human alveolar echinococcosis (AE) is a silently-progressing disorder that has become a threat in many countries. Since 2000, when the first case was recorded, the number of human AE patients in Slovakia is on continuous raise. The article presents a rare case of alveolar echinococcosis with infiltration in the adrenal gland and discusses the problems associated with differential diagnosis of the disease. In 2016, abdominal ultrasound performed due abdominal pain complaint showed the presence of cystic lesions in the right liver lobe of 54-year old female patient. During surgery, another lesion in the right adrenal gland was found, and neoplastic processes or echinococcosis were considered in the differential diagnosis. Due to unclear correlation between radiology, serology and histopathology results and endemic situation in Slovakia, molecular examination was recommended. Subsequently E. multilocularis was confirmed as etiological agent of infection. Alveolar echinococcosis is considered as a rare disease, with very few patients referred to clinicians or hospitals that sometimes have almost none existing experience with the diagnosis and treatment of the disease. Therefore, the establishment of networks or reference centres specialized on management of the disease would be suitable way to provide the patients with the best care and improve the disease diagnosis, treatment and prognosis.
Alveolar and cystic echinococcosis, serious parasitic diseases caused by larval stages of Echinococcus multilocularis and E. granulosus has been diagnosed in Slovakia for a long time. Study presents case of 49-years old patient with accidentally diagnosed one big (60 mm) and multiple small (2 - 24 mm) hypoechogenic structures localised in right liver lobe. According to positive serology to E. granulosus antigen and results of imaging examinations the patient was classifi ed as possible case of cystic echinococcosis and treated with mebendazole. Later, due to the worsening of clinical, laboratory and CT fi ndings surgical biopsy was performed and surgical biopsy and subsequent PCR examination of liver tissue confi rmed the diagnosis of alveolar echinococosis. Clinical picture of disease imitating cystic echinococcosis in presented case report, together with results of serological tests confi rmed importance of accurate differential diagnosis of echinococcosis. Each aspect of clinical and laboratory results should be considered responsibly, however, sometimes only molecular techniques can solve the problem of differential diagnosis.