The current case report presents a complex medical history, as the patient underwent allogeneic liver transplantation and lung segmental resection for alveolar echinococcosis with pulmonary metastases, followed by kidney resection due to significant compression and left-sided renal insufficiency. Renal alveolar echinococcosis appeared 2 years later, with no previous similar case report found.
The invasion of the second hepatic hilar makes it impossible to achieve radical resection via partial hepatic resection; thus, liver transplantation and removal of the basal segment of the left lower lung are the most suitable treatment options for this patient. Nevertheless, the development of renal alveolar echinococcosis 2 years later was a surprising turn of events. We advocate the conclusion that persistent occult renal infections evolve into active lesions following the administration of immunosuppressive drugs. The acceleration of the development of echinococcosis by immunosuppression has been confirmed by several studies [1, 4-8]. The patient relocated away from the infected area during conservative treatment with albendazole after the initial diagnosis, according to the follow-up results. On the contrary, the liver is still regarded as the primary infected organ in secondary infections, and there were no lesions in the liver on imaging during the nephrectomy treatment.
It is worth noting that active renal echinococcosis is generally caused by disseminated echinococcosis and is accompanied by persistent clinical symptoms of urinary tract infection[9-11]. In this instance, no anomalies were found during renal imaging taken between 2017-2020 (before immunosuppression treatment). However, it is essential to point out that the patient had concomitant and long-standing clinical indications of urinary tract infections at the time of the initial diagnosis of hepatic alveolar echinococcosis. In conclusion, the appearance of clinical symptoms of urinary tract infections in imaging-negative cases of cryptogenic renal echinococcosis implies a need for clinical management.
The management of imaging-positive lesions primarily influences the clinical regimen, and there is a need to consider possible occult lesions in patients with well-defined metastatic lesions. Administration of immunosuppressive drugs after liver transplantation in patients with hepatic echinococcosis may lead to the development of occult lesions into active lesions. Patients displaying clinical features of urinary tract infections may have image-negative cryptogenic renal echinococcosis. Clinical attention should be given to patients with hepatic alveolar echinococcosis who have prolonged unexplained coexisting urinary tract infections to prevent the potential development of cryptogenic renal foci. Such foci may become active and invade the liver, if possible. Due to the absence of reliable medications, albendazole could be considered the optimal choice for hindering the growth of active lesions; however, appropriate studies are unavailable to confirm its efficiency, prescribed amount, and administration frequency.