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This patient, in her early 20s, presented with a fever associated with worsening abdominal pain, as well as a background history of chronic abdominal pain, anorexia, vomiting, constipation and weight loss. The radiology revealed an irregular complex cyst in the liver with biliary and vascular invasion, raising concerns about hepatocellular carcinoma. The diagnosis was changed to <jats:italic>alveolar echinococcosis<\/jats:italic> after the infectious diseases consultant gave helpful advice, and <jats:italic>echinococcosis<\/jats:italic> antibodies were found. We subsequently started the patient on albendazole therapy. Following prudent advice from hepatobiliary surgeons and given the complexity of the hepatic lesion, a liver transplant was considered the best management option due to the extensive involvement of the biliary and venous systems. The combined approach of albendazole and a liver transplant marked a transformative phase for this patient, putting an end to her prolonged suffering.<\/jats:p>","DOI":"10.1136\/bcr-2024-259701","type":"journal-article","created":{"date-parts":[[2024,9,6]],"date-time":"2024-09-06T01:45:20Z","timestamp":1725587120000},"page":"e259701","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Rare presentation of hepatic alveolar echinococcosis mimicking hepatocellular carcinoma"],"prefix":"10.1136","volume":"17","author":[{"given":"Alvina","family":"Zanib","sequence":"first","affiliation":[{"name":"Infecious Diseases\/General Medicine, University Hospital Limerick, Limerick, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed Abdelaziz","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Infecious Diseases\/General Medicine, University Hospital Limerick, Limerick, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonella","family":"Salvia Milos","sequence":"additional","affiliation":[{"name":"Infecious Diseases\/General Medicine, University Hospital Limerick, Limerick, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Syed Shabbar","family":"Musavi","sequence":"additional","affiliation":[{"name":"General Medicine, University Hospital Limerick, Limerick, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,9,5]]},"reference":[{"key":"2025082700201109000_17.9.e259701.1","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1016\/S1665-2681(19)31929-5","article-title":"Spontaneous rupture of a giant non parasitic hepatic cyst presenting as an acute surgical abdomen","volume":"6","author":"Salemis","year":"2007","journal-title":"Ann Hepatol"},{"key":"2025082700201109000_17.9.e259701.2","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1136\/bcr-2019-230243","article-title":"Simple hepatic cyst rupture exacerbated by anticoagulation","volume":"12","author":"Tong","year":"2019","journal-title":"BMJ Case Rep"},{"key":"2025082700201109000_17.9.e259701.3","doi-asserted-by":"crossref","first-page":"621","DOI":"10.2169\/internalmedicine.45.1408","article-title":"Nonparasitic solitary giant hepatic cyst causing obstructive jaundice was successfully treated with monoethanolamine oleate","volume":"45","author":"Miyamoto","year":"2006","journal-title":"Int Med"},{"key":"2025082700201109000_17.9.e259701.4","doi-asserted-by":"crossref","unstructured":"Enke T , Manatsathit W , Merani S , et al . 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