Arch Clin Infect Dis. 2018 December; 13(6):e57823. Published online 2018 October 15. doi: 10.5812/archcid.57823. Case Report Bone Hydatid Disease with Long Term Follow-Up: A Case Report Majid Abedi 1 , Amin Karimi 1 , Salman Ghaffari 2 , Azra Izanloo 3 and Masoud Mirkazemi 1, * 1 Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran 2 Orthopedic Research Center, Tehran, Iran 3 Razavi Cancer Research Center, Razavi Hospital, Imam Reza International University, Mashhad, Iran * Corresponding author: Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran. E-mail: masoud.dr2003@gmail.com Received 2017 July 09; Revised 2018 July 23; Accepted 2018 August 12. Abstract Introduction: Hydatid cysts of bones may develop in any part of the body, however, they are usually found in the liver and lungs. The primary localization of the cysts in bone is not common. Case Presentation: In this paper, we report the case of a 58-year-old man who was admitted complaining of leg pain. He had un- dergone hydatid cyst surgery several times over the past years. Conclusions: The patient had surgical removal of the hydatid cyst along with chemotherapy before and after surgery. The patient did not report any problem in a two-year follow-up after his last surgery. Keywords: Hydatid Cyst, Bone, Recurrence, Surgery 1. Introduction Human echinococcosis is a zoonotic infection caused by larval cyst of the dog tapeworm Echinococcus granulo- sus (E. granulosus), which mainly affects the liver and lungs. The parasite appears in two forms, E. granulosus and E. mul- tilocularis. The former often chooses humans, sheep, and cattle as the intermediate host. A dog is the most com- mon definitive host that transmits this larva to humans through direct contact (1). In endemic areas such as the Middle East, Central Asia, South America, East Africa, and Turkey, hydatidosis is relatively common, particularly in areas of poor hygiene (2). In 75% of all cases, larvae are found in the liver and in 5% of cases, they reside in lungs, with 10% of cases involving other organs. Bone hydatid dis- ease is extremely rare, approximately in 0.5% to 2.5% of all human hydatidosis (3). Tibia involvement is observed in up to 10% of all bone cases. Due to its unusual presenta- tion, its diagnosis may be easily missed, unless meticulous attention is paid to its diagnosis (4). Although long term survival is possible, the disease cannot be easily eradicated and may be resistance to treatment (5). Since patients usu- ally refer at an advanced stage of the disease, treatment is difficult and recurrence is common (6). We report a case of recurrent hydatidosis disease of the tibia in a 58-year-old man with long term follow-up. 2. Case Presentation We presented the case of a 58 year old man suffering from pain in his left leg. In this case, he used to keep animals such as sheeps and dogs at his house. In addi- tion, two and six years ago, the results of radiography had showed cystic lesions in the left tibia (Figures 1 and 2). He had two operations for treating hydatid disease caused by Echinococcus granolosus. In another hospital, he had been treated by adjuvant therapy with albendazole in the same region. In that case, pathological results con- firmed the hydatid cyst. Once again, he referred complain- ing of leg pain and the X-ray of his paining leg showed a lucent and multilocular lesion (Figure 3). The clinical examination revealed a normal range of motion in both knees without local swelling. In the primary evaluation of the patient, white blood cell count (WBC), differential count, and erythrocyte sedimentation rate (ESR) were nor- mal. The patient’s lung and liver were also screened and his abdominal ultrasonography and chest radiography were normal. Chemotherapy with albendazole 400 mg (once a day) was performed 4 weeks prior to the surgery. He under- went surgery during which hydatid suspicious cysts were found (It was fertile). Thus, curettage was administered and the wound was cleaned with solution hydrogen prox- ide (H 2 O 2 ) to prevent the recurrence of the cyst (Figure 4). One month after operation, chemotherapy with albenda- Copyright © 2018, Archives of Clinical Infectious Diseases. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.