背景和目的:肺泡包虫病(AE)是一种高度可变的疾病,能够根据宿主的免疫状态以及诊断与原发感染之间的时间在不同器官中表现为结构多样的囊肿。细菌超感染,特别是梭菌属的厌氧病原体,可以进一步改变由于Fneumobilia的放射学发现,新形成的脓肿形成,和炎症变化。材料和方法:我们介绍了一例71岁的白种人男性因感染性休克入院,不动,肝脏的一个复杂的囊肿伴有钙化,如初始CT所示。因为感染性休克,患者开始接受宽带抗生素治疗.梭菌科感染被认为是重要的鉴别诊断,因为在最初的CT中观察到了血栓形成,没有内窥镜检查史。此外,棘球球菌的血清学呈阳性,血培养显示产气荚膜梭菌生长。因此,患者还接受了阿苯达唑治疗.恢复后,进行了进一步分期,显示囊肿完全缓解和遗留病变,分类为肺泡棘球蚴病Ulm分类(AEUC)V。病人有一个预先存在的,受控的AE感染被产气荚膜梭菌过度感染,可能归因于厌氧坏死组织,导致败血症.结果:AE囊肿内的厌氧组织为产气荚膜梭菌复制提供了理想的培养基,导致囊肿感染,随后引起了脓毒性休克和血栓形成.CT和MRI的最初发现与双重感染混淆,证明AE的诊断挑战,尤其是出现并发症时。结论:诊断AE仍然是一项艰巨的任务,即使有血清学提供的优秀工具,加上CT,FDG-PET-CT,MRI。值得注意的是,合并到适当的诊断环境中时,较老的过度感染的囊肿可能会带来困难。及时诊断对于包虫病及其并发症的准确治疗至关重要,如细菌超感染。从临床的角度来看,梭状芽胞杆菌的败血症和产气荚膜梭菌感染-能够诱导血栓形成的病原体-应被视为在没有内窥镜检查史的情况下对血栓形成的重要鉴别诊断。
Background and Objectives: Alveolar echinococcosis (AE) is a highly variable disease able to present as structurally diverse cysts in different organs based on the host\'s immunological state as well as the time between diagnosis and the primary infection. Bacterial superinfections, especially with anaerobic pathogens from the Clostridiaceae genus, can further alter the radiological findings due to pneumobilia, newly formed abscess formations, and inflammatory changes. Materials and Methods: We present a
case of a 71-year-old Caucasian male admitted to our intensive care unit with septic shock, pneumobilia, and a complex cyst of the liver with calcification, as shown by an initial CT. Because of the septic shock, the patient was started on broad-band antibiotics. Clostridiaceae infection was considered an important differential diagnosis due to the presence of pneumobilia observed in the initial CT, without a history of previous endoscopy. Furthermore, serology for echinococcus was positive, and blood cultures showed growth of C. perfringens. Therefore, the patient was additionally treated with albendazole. After recovery, further staging was conducted, showing complete remission of the cyst and a left-over lesion classified as Alveolar Echinococcosis Ulm Classification (AEUC) V. In summary, the patient had a pre-existing, controlled AE infection that became superinfected with C. perfringens, likely attributable to the anaerobic necrotic tissue, leading to septicemia. Results: The anaerobic tissue within the AE cyst provided an ideal medium for C. perfringens to replicate, leading to cyst infection, which subsequently caused septic shock and pneumobilia. The initial findings from CT and MRI were confounded by the
superinfection, demonstrating the diagnostic challenges of AE, especially when presenting with complications. Conclusions: Diagnosing AE remains a demanding task, even with the excellent tools available through serology, coupled with CT, FDG-PET-CT, and MRI. Notably, older superinfected cysts can pose difficulties when integrated into the appropriate diagnostic context. Prompt diagnosis is critical for the accurate treatment of echinococcosis and its complications, such as bacterial superinfections. From a clinical perspective, septicemia from Clostridiaceae and infections with C. perfringens-pathogens capable of inducing pneumobilia-should be regarded as significant differential diagnoses for pneumobilia in the absence of a recent history of endoscopy.