{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,21]],"date-time":"2025-12-21T13:46:36Z","timestamp":1766324796248,"version":"3.48.0"},"reference-count":15,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,11,21]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:p>\n                    An early-adolescent girl from a hydatid-endemic region presented with 3\u2009months of intermittent fever, cough with two episodes of haemoptysis, abdominal pain and fatigue. Examination was non-specific apart from right-upper-quadrant tenderness. Serology for\n                    <jats:italic>Echinococcus granulosus<\/jats:italic>\n                    was positive. Chest radiography and cross-sectional imaging demonstrated multiple hydatid cysts within both lungs, both hepatic lobes and the left kidney, with internal membranes and the pathognomonic \u2018serpent sign\u2019 in one pulmonary cyst. Given multiplicity and distribution across three organs, percutaneous drainage and surgery were deferred. Albendazole (approximately 15\u2009mg\/kg\/day in two divided doses) was administered for 12 weeks with clinical improvement and planned radiological surveillance. This case illustrates the diagnostic approach to disseminated cystic echinococcosis in children, rational selection of non-operative management when operative risk is high and the public health implications for clinicians practising in non-endemic settings who care for migrant and travelling populations.\n                  <\/jats:p>","DOI":"10.1136\/bcr-2025-270029","type":"journal-article","created":{"date-parts":[[2025,12,21]],"date-time":"2025-12-21T13:45:25Z","timestamp":1766324725000},"page":"e270029","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Disseminated paediatric cystic echinococcosis with pulmonary, hepatic and renal involvement managed medically in a low-resource endemic setting"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1656-3144","authenticated-orcid":false,"given":"Syed","family":"Nisar Ahmad","sequence":"first","affiliation":[{"name":"Paediatrics, United Lincolnshire Hospitals NHS Trust, Boston, UK"},{"name":"Paediatrics, Bolan Medical College, Quetta, Balochistan, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Syed","family":"Umair Ahmed","sequence":"additional","affiliation":[{"name":"Paediatrics, Bolan Medical College, Quetta, Balochistan, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ainan","family":"Arshad","sequence":"additional","affiliation":[{"name":"Acute Medicine, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,12,21]]},"reference":[{"key":"2025122105451956000_18.12.e270029.1","doi-asserted-by":"crossref","first-page":"704","DOI":"10.24953\/turkjped.2019.05.009","article-title":"Characteristics, diagnosis, and treatment modality of pediatric patients with cystic echinococcosis: a single centre experience","volume":"61","author":"Kaman","year":"2019","journal-title":"Turk J Pediatr"},{"key":"2025122105451956000_18.12.e270029.2","first-page":"726","article-title":"Primary disseminated hydatid cysts in a 14-year-old girl: a case report","volume":"55","author":"Fallah","year":"2018","journal-title":"Acta Med Iran"},{"key":"2025122105451956000_18.12.e270029.3","article-title":"Disseminated Hydatid Disease in a Child Involving Multiple Organ Systems: A Case Report","volume":"12","author":"Shabbir","year":"2020","journal-title":"Cureus"},{"key":"2025122105451956000_18.12.e270029.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.actatropica.2014.03.014"},{"key":"2025122105451956000_18.12.e270029.5","doi-asserted-by":"publisher","DOI":"10.1093\/tropej\/fmn054"},{"key":"2025122105451956000_18.12.e270029.6","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1007\/s00268-004-7029-9","article-title":"Conservative surgery for treatment of hydatid cysts in children","volume":"28","author":"T\u00fcrkyilmaz","year":"2004","journal-title":"World J Surg"},{"key":"2025122105451956000_18.12.e270029.7","first-page":"364","article-title":"Epidemiological and Clinical Characteristics of Patients with Hydatid Cysts in Khorasan Razavi Province, from 2011 to 2014","volume":"11","author":"Khazaei","year":"2016","journal-title":"Iran J Parasitol"},{"key":"2025122105451956000_18.12.e270029.8","unstructured":"World Health Organization . WHO guidelines for the treatment of patients with cystic echinococcosis. Geneva: World Health Organization, 2025. Available: https:\/\/www.who.int\/publications\/i\/item\/9789240110472"},{"key":"2025122105451956000_18.12.e270029.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.actatropica.2009.11.001"},{"key":"2025122105451956000_18.12.e270029.10","unstructured":"WHO-IWGE classification (imaging): Radiopaedia . WHO-IWGE classification of cystic echinococcosis (CE1\u2013CE5). n.d. Available: https:\/\/radiopaedia.org\/articles\/cystic-echinococcosis"},{"key":"2025122105451956000_18.12.e270029.11","doi-asserted-by":"publisher","DOI":"10.1007\/s003830050024"},{"key":"2025122105451956000_18.12.e270029.12","article-title":"Management of Massively Enlarged Multiple Hydatid Cysts in the Liver of a Pediatric Patient","volume":"9","author":"Yasin","year":"2017","journal-title":"Cureus"},{"key":"2025122105451956000_18.12.e270029.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2006.03.005"},{"key":"2025122105451956000_18.12.e270029.14","doi-asserted-by":"crossref","unstructured":"Iqbal N , Hussain M , Idress R , et al . Disseminated hydatid cyst of liver and lung. 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