Echinococcosis as a cause of infertility.

N Bakshi, RK Saran, R Nada 
 Department of Cytology and Gynaecological Pathology, P.G.I.M.E.R., Chandigarh.

Correspondence Address:
N Bakshi
Department of Cytology and Gynaecological Pathology, P.G.I.M.E.R., Chandigarh.

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::   Introduction

Echinococcosis or hydatid disease is an infestation by the larval tapeworm, Echinococcus granulosus. Hydatid disease in human is a serious and potentially dangerous problem. However, size and organ location greatly influence the clinical presentation and outcome. The common sites are the liver (60%), lungs (20%), kidney (4%), spleen, soft tissue and brain (3%) each and bone (2%)[1]. The female genital tract is uncommonly involved and is rarely the primary site of hydatid cyst formation. The Bicker’s series[2] of 532 Lebanese patients reported only four and two cases with ovarian and uterus involvement respectively. Clinical presentation includes a pelvic mass and if the patient is pregnant, obstructed labour[3]. But infertility as a presenting feature has not been documented in literature.

::   Case report

A 29-year-old female, presented with eight years history of primary infertility. Investigations revealed bilateral tubal block. Laproscopy was done and a diagnosis of tubercular salpingitis was suggested. Endometrial biopsy showed focal granulomatous inflammation only. However positivity for acid fast bacilli could not be documented. The patient was empirically put on combination chemotherapy for tuberculosis. After a nine month course of triple drug anti-tubercular therapy the patient still had bilateral tubal block. At this stage diagnostic laproscopy was repeated, which showed multiple tubercle like nodules ranging from 0.5 to 1.5 cm in diameter on the serosal aspect of the uterus, the tubes and pelvic peritoneum. Histological section of the excised tubal nodules showed many parasitic profiles comprising of scolices, acid fast hooklets and calcareous corpuscles [Figure:1]. There was synechiae formation between tubal plicae and granulomatous reactions around scolices in the tubal wall, features conforming to the histological picture of degenerated hydatid cyst[4].

::   Discussion

Echinococcus may invade any site of the body, but its occurrence in fallopian tube has not been reported. This case of echinococcosis is unusual because of its peculiar presentation of long-standing primary infertility. The cause of primary infertility in this case was due to tubal blockage by echinococcus. Although other parasites causing primary infertility are known[5], but echinococcosis of tubal area causing infertility is a rare occurrence. Radiographic and related imaging studies like CT scan and ultrasonography are important in detecting and evaluating echinococcal cysts. Serological diagnosis can be useful, although a negative test does not exclude the diagnosis of echinococcosis. Detection of antibody to a specific echinococcal antigen (antigen 5 or Arc 5) has the highest degree of specificity, especially in combination with the new enzyme linked immunoelectrotransfer blot test (EITB)[6].

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