Abstract Introduction Co-infection of hydatid cyst in the lung and pulmonary tuberculosis is rare even in endemic areas. The two diseases have no direct biological link, have opposing immune mechanisms and can cause diagnostic confusion due to overlapping symptoms and signs. Case report A 9-year-old male, from Eastern Cape, South Africa, presented to his local hospital with a one-week history of a productive cough, generalized body weakness and night sweats. He was severely thin on admission with a BMI of 11.1. He was HIV unexposed with no known Mycobacterium tuberculosis contact and had no prior medical history. On examination, he had a heart rate of 111 bpm and a respiratory rate of 22. He was apyrexial with a temperature of 36.6 and saturating at 94% oxygen in room air. Cervical lymphadenopathy was noted. There was dullness to percussion over the right middle and lower zones with decreased air entry. Initial blood investigations showed a WCC of 21 x109, an eosinophil count of 17,48 x109 (48,8%) and an HB of 12.8g/dL. His CRP was 42mg/L and ESR 20mm/hr. His chest X-ray showed a round, cystic lesion with an air-fluid level in the right lower zone. He was treated as a complicated pneumonia with possible lung abscess and referred to our tertiary facility for further workup and management.At our facility he was treated with intravenous Cloxacillin and Augmentin, and he was investigated for pulmonary TB and hydatid disease. One induced sputum for TB GeneXpert was positive and Rifampicin sensitive, with a positive M. tuberculosis culture. Subsequently, complicated pulmonary TB treatment (Rifampicin, Isoniazid, Pyrazinamide and Ethambutol) was started. A computed tomography scan of the chest showed a cystic lesion (59mm x 44mm) in the right lower lung zone with a soft tissue component of 21mm in depth. There were scattered opacities in both lungs with circumferential hilar lymphadenopathy. Lastly, a cystic lesion was found in the liver measuring 44 x 48mm. The Echinococcus IgG serology was positive, (21.55 U/mL). The patient was referred to his base hospital to complete 6/52 of Augmentin and 6/12 of TB treatment. Albendazole was started, and the patient was referred to cardiothoracic surgery for right lower lobectomy. Conclusion In endemic regions, considering the two infections in the differential diagnosis when imaging is suggestive, is important. This abstract is funded by: None
Ferguson et al. (Fri,) studied this question.