Neotropical Echinococcosis Complicated by Hepatic Abscess and Hepato-Pleural Fistula: A Case Report From the State of Acre, Brazil.

Polycystic echinococcosis is a parasitic disease caused by cestodes of Echinococcus vogeli, which occurs in rural and wild areas of Central and South America. Its definitive hosts are Speothos venaticus (bush dog) and Canis familiaris (domestic dog), while Cuniculus paca (paca) serves as the intermediate host. Humans become accidental hosts by consuming food or water contaminated with eggs of this helminth. In the Amazon, due to geographic, economic, and cultural factors, rural populations often consume wild meat as a main protein source. The viscera of pacas are used to feed domestic dogs, perpetuating the life cycle of E. vogeli. We describe a rural patient with hepatitis B virus (HBV)-related cirrhosis and neotropical echinococcosis who developed a hepatic abscess that fistulized into the right hemithorax. Due to the low hepatic reserve and extensive liver involvement, the conventional surgical approach for echinococcosis was contraindicated.