ISPUB.COM The Internet Journal of Pulmonary Medicine Volume 6 Number 1 1 of 3 Albendazole Induced Rupture Of Pulmonary Hydatid Cysts P Koul, M Kanjwal Citation P Koul, M Kanjwal. Albendazole Induced Rupture Of Pulmonary Hydatid Cysts. The Internet Journal of Pulmonary Medicine. 2005 Volume 6 Number 1. Abstract Six patients of pulmonary hydatid disease who developed rupture of their cysts upon treatment with albendazole started prior to percutaneous aspiration (n=4) and /or surgery (n=2) are presented. The patients had been put on albendazole for sterilization of the cysts prior to the procedure. The rupture resulted is sudden cough (n= 6), breathlessness (n=3), chest pain ( n= 2) and wheezing (n= 2) accompanied by expectoration of a salty fluid containing whitish membrane like structures. The expectorated material was found to contain hydatid scolices in each case. The rupture alongside continued albendazole therapy was curative in 2 cases and a regrowth was observed in 5 cysts. No spillage hydatidosis was seen. Albendazole therapy can cause a rupture in some patients with pulmonary hydatid disease and should be suspected in any such patient who presents with sudden onset respiratory symptoms. The rupture may be curative in some but the patients need to be followed for regrowth or development of spillage induced secondary hydatidoses. INTRODUCTION Pulmonary hydatidosis is a common clinical entity seen in the Kashmir valley of the Indian subcontinent. [ 1 ]. The patients are either picked upon routine radiography or can have diverse clinical presentations, mostly related to the mass effect of the growing cyst. Medical, surgical and aspiration have been used for treatment of the disease. Spontaneous rupture of the cyst can be an initial presentation of an asymptomatic disease. Albendazole has been reported to effect a rupture of the hydatid cysts. We present a series of 6 patients (7 cyts) who developed rupture of the cyst while on albendazole therapy. CASES, METHODS AND RESULTS The six patients of pulmonary hydatid disease consisted of 4 males and 2 females with ages ranging from 19 to 38 (median 26) years. The patients had been diagnosed as having hydatid cystic disease on the basis of radiographic studies of the thorax along with positive serology. Three patients had right-sided solitary cysts, 2 had left sided cysts and one had multiple bilateral cysts. The patients were offered various therapeutic options and chose aspiration (n=4) and surgery (n=2). As a routine the patients were put on pre procedure albendazole therapy with an aim to sterilize the cyst contents so as to prevent spillage associated dissemination. The cyst rupture occurred on days 7, 8,10 (n=2), 11 and 13 of the initiation of albendazole. All patients developed sudden onset of coughing accompanied by expectoration of a saline fluid containing whitish glistening membrane like structures. Three patients had associated bronchospasm and two patients developed fever over the next 12 hours. None of the patients developed any evidence of systemic anaphylaxis. Radiographs of the chest obtained after the onset of the symptoms revealed a collapse of cysts with changed morphology. Examination of the expectorated material in each case was positive for the scolices of the Echinococcus. The procedures was deferred in all patients in view of the rupture of the cyst. Albendazole was continued in all patients to prevent potential risk of the dissemination of the disease. One patient developed fever and was treated with antibiotics which eventually subsided with out any complication. Another patient who had multiple cysts received multiple cycles of albendazole therapy and had a significant reduction in cyst size and had asymptomatic rupture of another cyst one month later. The patient had complete disappearance of the ruptured cyst. Another two patients decided to go for surgery. DISCUSSION Pulmonary hydatid cyst has been traditionally treated with surgery but in past few years bezamidazole group of drug have been increasingly used for the treatment as well as for prophylaxis both pre- as well as post operatively [ 2 ]. Hydatid cyst rarely heals by spontaneous rupture into the bronchus.