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52-jähriger Patient mit subkutaner Raumforderung unter Immunsuppression

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Zusammenfassung

Wir berichten von einem 52-jährigen Patienten, der ein halbes Jahr nach Lebertransplantation wegen Hepatitis-C-assoziierter Leberzirrhose an einer subkutanen alveolären Echinokokkose erkrankte. Weder in der explantierten noch in der transplantierten Leber fand sich ein Echinokokkoseherd, so dass von einer seltenen primär extrahepatischen Erstmanifestation auszugehen ist. Interessanterweise kam es zur Ausbildung von Bandwurmkopfanlagen. Diese Ausbildung von geschlechtsreifen Bandwürmern stellt beim Menschen eine Rarität dar, die möglicherweise auf die Immunsuppressison nach Lebertransplantation zurückzuführen ist. Durch Radikaloperation des Hauttumors und eine postoperative Albendazoltherapie konnte der Patient kurativ behandelt werden. Eine gleichzeitig bestehende Hepatitis-C-Reinfektion (Genotyp 2b) wurde erfolgreich mit Interferon α2b und Ribavirin behandelt.

Abstract

We report the case of a 52-years-old male patient, who was diagnosed with subcutaneous alveolar echinococcosis 6 months after liver transplantation for HCV-related cirrhosis. Neither the explanted nor the transplantated liver revealed an echinococcus focus. Therefore a rare primary extrahepatic manifestation was likely. Interestingly, the echinococcal larvae had developed protoscolices. The development of mature tapeworms in human is a rarity, which could be related to the immunosuppressive therapy after liver transplantation. The patient was curatively treated by surgical removal of the subcutaneous tumor and a postoperative therapy with albendazole. Furthermore, HCV reinfection (genotype 2b) was successfully treated with interferone α2b and ribavirine for 6 months.

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Literatur

  1. Ahmed A, Keeffe EB (2001) Hepatitis C virus and liver transplantation. Clin Liver Dis 5: 1073–1090

    Google Scholar 

  2. Ammann RW, Eckert J (1996) Cestodes. Echinococcus. Gastroenterol Clin North Am 25: 655–689

  3. Bilzer M, Rau HG, Schauer R, Gerbes AL (2000) Lebertransplantation—Indikationsstellung und Probleme in der internistischen Nachsorge. Bay Int 20: 212–222

    Google Scholar 

  4. Bresson-Hadni S, Koch S, Beurton I et al. (1999) Primary disease recurrence after liver transplantation for alveolar echinococcosis: Long-term evaluation in 15 patients. Hepatology 30: 857–864

    Google Scholar 

  5. Eckert J, Deplazes P (1999) Alveolar echinococcosis in humans: the current situation in Central Europe and the need for countermeasures. Parasitol Today 15: 315–319

    Google Scholar 

  6. Gottstein B (2000) Epidemiologie und Systematik der cystischen und alveolären Echinokokkose. Chirurg 71: 1–8

    Google Scholar 

  7. Harraga S, Godot V, Bresson-Hadni S, Pater C, Beurton I, Bartholomot B, Vuitton DA (1999) Clinical efficacy of and switch from T helper 2 to T helper 1 cytokine profile after Interferon α2a monotherapy for human Echinococcosis. Clin Infect Dis 29: 205–206

    Google Scholar 

  8. Ioppolo S, Notargiacomo S, Profumo E, Franchi C, Ortona E, Rigano R, Siracusano A (1996) Immunological responses to antigen B from Echinococcuc granulosus cyst fluid in hydatid patients. Parasite Immunol 18: 571–578

    Google Scholar 

  9. Ito A, Ma L, Schantz PM et al. (1999) Differential serodiagnosis for cystic and alveolar echinococcosis using fractions of Echinococcus granulosus cyst fluid (antigen B) and E. multilocularis protoscolex (EM18). Am J Trop Med Hyg 60: 188–192

    Google Scholar 

  10. Jenne L, Kilwinski J, Radloff P, Flick W, Kern P (1998) Clinical efficacy of and immunologic alterations caused by Interferon γ therapy for alveolar echinococcosis. Clin Infect Dis 26: 492–494

    Google Scholar 

  11. Reuter S, Jensen B, Buttenschoen K, Kratzer W, Kern P (2000) Benzimidazoles in the treatment of alveolar echinococcosis: a comparative study and review of the literature. J Antimicrob Chemother 46: 451–456

    Google Scholar 

  12. Reuter S, Seitz HM, Kern P, Junghanss T (2000) Extrahepatic alveolar echinococcosis without liver involvement: a rare manifestation. Infection 28: 187–192

    Google Scholar 

  13. Schmid M, Samonigg H, Stöger H, Auer H, Sternthal MH, Wilders-Truschnig M, Reisinger EC (1995) Use of Interferon γ and mebendazole to stop the progression of alveolar hydatid disease: Case report. Clin Infect Dis 20: 1543–1546

    Google Scholar 

  14. WHO Informal Working Group on Echinococcosis (1996) Guidelines for treatment of cystic and alveolar echinococcosis in humans. Bull Wld Hlth Org 74: 231–242

    Google Scholar 

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Authors and Affiliations

  1. Medizinische Klinik II, Klinikum Großhadern, Ludwig-Maximilians-Universität München

    F. T. Kolligs, A. L. Gerbes, E. M. Dürr & M. Bilzer

  2. Chirurgische Klinik, Klinikum Großhadern, Ludwig-Maximilians-Universität München

    R. Schauer

  3. Institut für radiologische Diagnostik, Klinikum Großhadern, Ludwig-Maximilians-Universität München

    M. Kessler

  4. Abteilung für Infektions- und Tropenmedizin, Medizinische Klinik Innenstadt, Ludwig-Maximilians-Universität München

    T. Jelinek & T. Löscher

  5. Medizinische Klinik II, Klinikum Großhadern der Universität München, Marchioninistraße 15, 81377, München

    F. T. Kolligs

Authors
  1. F. T. Kolligs
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  2. A. L. Gerbes
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  3. E. M. Dürr
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  4. R. Schauer
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  5. M. Kessler
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  6. T. Jelinek
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  7. T. Löscher
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  8. M. Bilzer
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Correspondence to F. T. Kolligs.

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Kolligs, F.T., Gerbes, A.L., Dürr, E.M. et al. 52-jähriger Patient mit subkutaner Raumforderung unter Immunsuppression. Internist 44, 740–745 (2003). https://doi.org/10.1007/s00108-003-0862-3

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  • DOI: https://doi.org/10.1007/s00108-003-0862-3

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