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\begin{document}

\title{Severe multilobar lung echinococcosis with multi-organ involvement in a
child}



\author[1]{Şükrü  Güngör }%
\author[1]{Sadık Yurttutan}%
\author[1]{Adil Doğan}%
\affil[1]{Kahramanmaras Sutcu Imam Universitesi Tip Fakultesi}%


\vspace{-1em}



  
  \date{June 14, 2024}


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\selectlanguage{english}
\begin{abstract}
Our case was a pediatric patient with very extensive lung involvement
who also had involvement in other organs. We believe our case
demonstrates clinical features that are complementary for the case
series by Mfingwana L and colleagues and thus, will be beneficial for
the readers.%
\end{abstract}%



\sloppy


\textbf{Severe multilobar lung echinococcosis with multi-organ
involvement in a child}

\textsuperscript{\textbf{1}} \selectlanguage{polish}Ş\selectlanguage{ngerman}ükrü Güngör,
\textsuperscript{\textbf{2}}Sad\selectlanguage{polish}ı\selectlanguage{english}k Yurttutan,
\textsuperscript{\textbf{3}} Adil Do\selectlanguage{polish}ğ\selectlanguage{english}an

\textsuperscript{1} Sutcu Imam University Faculty of Medicine,
Department of Pediatrics, Division of Pediatric Gastroenterology

\textsuperscript{2} Sutcu Imam University Faculty of Medicine,
Department of Pediatrics,Division of Neonatology, Kahramanmaras, Turkey

\textsuperscript{3} Sutcu Imam University Faculty of Medicine,
Department of Radiology

Running Head: \textbf{Lung echinococcosis with multi-organ involvement
in a child}

Word number: 346

Page number: 1

Figure:1

\textbf{Corresponding author:}

Sad\selectlanguage{polish}ı\selectlanguage{english}k Yurttutan, M.D.

Address: Sutcu Imam University Faculty of Medicine, Department of
Pediatrics, Division of Neonatology. Kahramanmaras, Turkey,

E-mail: dryurttutan@gmail.com

Phone number: +9005300400175

ORC\selectlanguage{polish}İ\selectlanguage{english}D ID: 0000 0002 4994 9124

\textbf{Conflict of interest:} No potential conflicts of interest were
reported by the authors

\textbf{Funding:} I have not declared a specific grant for this research
from any funding agency in the public, commercial or not-for-profit
sectors

\textbf{Severe multilobar lung echinococcosis with multi-organ
involvement in a child}

To the Editor;

We read with great curiosity the study by Mfingwana L and colleagues, in
which they evaluated cases of pulmonary echinococcosis. In the study,
the authors described 35 pediatric cases between ages 3-13 with lung
involvement, of which 74\% had single lobe involvement. Only 9 cases had
exhibited multiple lobe involvement. Furthermore, 8 cases were reported
to also have organ involvement beyond the lung, with majority exhibiting
hepatic involvement. \textsuperscript{1} Thus, patients presenting with
symptoms associated with lung involvement should also be considered for
involvement in other organs.

We would like to share a 16 year old pediatric case who presented to our
clinic with solely a cough; following a clinical evaluation, the patient
was diagnosed with severe multilobar lung echinococcosis. Although the
patient only complained of a cough, chest radiograph and subsequent
thorax CT imaging revealed several apparent multilobar cystic lesions
(Figure 1a, 1b). Furthermore, IHA evaluation tested positive
\textgreater{}1/1280 for echinococcous antibodies.

Additional evaluation of the patient revealed echinococcous cysts in the
liver, spleen and kidneys (Figure 1e, 1c, 1d). The cysts in the liver
and spleen were particularly vast and widespread. The renal involvement
was especially significant in this case. Limited number of studies have
reported renal involvement in pediatric cases.\textsuperscript{2} In the
study by Mfingwana L and colleagues, only 2 cases with lung involvement
additionally had spleen involvement, while no case of renal involvement
was observed. In the literature, renal involvement is reported in nearly
1-3\% of echinococcosis cases.\textsuperscript{3} In our case; in
addition to massive multilobar lung involvement, the patient clearly
exhibited liver, spleen and kidney involvement.

The extent of such additional multi-organ involvement is extremely rare
in pediatric case series. The case series by Mfingwana L and colleagues
is very beneficial to clinicians for interpretation of the topic.

Our case was a pediatric patient with very extensive lung involvement
who also had involvement in other organs. We believe our case
demonstrates clinical features that are complementary for the case
series by Mfingwana L and colleagues and thus, will be beneficial for
the readers.

With much respects

\textbf{References:}

1) Mfingwana L, Goussard P, van Wyk L, Morrison J, Gie AG, Mohammed RAA,
Janson JT, Wagenaar R, Ismail Z, Schubert P. Pulmonary Echinococcus in
children: A descriptive study in a LMIC. Pediatr Pulmonol. 2022 Feb 4.
doi: 10.1002/ppul.25854. Epub ahead of print. PMID: 35122423.

2) Rami M, Khattala K, ElMadi A, Afifi MA, Bouabddallah Y. The renal
hydatid cyst: report on 4 cases. Pan Afr Med J. 2011;8:31. doi:
10.4314/pamj.v8i1.71147. Epub 2011 Mar 22. PMID: 22121440; PMCID:
PMC3201596.

t) Ciftci TT, Unal E, Azizova A, Ayyildiz VA, Akinci D, Akhan O. Renal
Cystic Echinococcosis: Long-Term Outcomes of Percutaneous Treatment. J
Vasc Interv Radiol. 2021 Jun;32(6):890-895.e2. doi:
10.1016/j.jvir.2021.03.519. Epub 2021 Mar 13. PMID: 33727151.

\textbf{Figure Legend:}

\textbf{Figure 1a)} PA akci\selectlanguage{polish}ğ\selectlanguage{english}er grafisinde bilateral multipl say\selectlanguage{polish}ı\selectlanguage{english}da
nod\selectlanguage{ngerman}üler opasiteler görülmektedir. Numerous bilateral nodular opacities
are seen on the postero-anterior chest X-ray.

\textbf{Figure 1b)} Contrast unenhanced thorax computed tomography
reveals multiple, nodular, well-circumscribed masses in bilateral lungs.

\textbf{Figure 1c)} Contrast-enhanced abdominal computed tomography
shows multiple nodular cystic lesions involving all segments in the
liver and nodular cystic lesions in the spleen (Both black arrows).

\textbf{Figure 1d)} Contrast-enhanced abdominal computed tomography
shows a nodular cystic lesion in the left kidney (black arrow).\selectlanguage{english}
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