Albendazole Monotherapy and Spleen Preservation in an Adolescent with Isolated Primary Splenic Cystic Echinococcosis: A Case Report

Cystic echinococcosis (CE), caused by Echinococcus granulosus sensu lato, most commonly involves the liver and lungs, whereas the spleen is an uncommon site, accounting for less than 2% of cases; isolated primary splenic involvement is rarer still and is only sporadically reported in children. Total splenectomy has traditionally been the standard treatment for splenic CE, yet it carries a lifelong risk of overwhelming post-splenectomy infection, a particularly relevant concern in a child. We describe a 13-year-old boy from a rural, sheep-rearing area of eastern Sicily in whom a splenic cyst was incidentally detected on ultrasonography performed after minor blunt abdominal trauma. Ultrasound and contrast-enhanced computed tomography showed a 3.7 cm cyst with a partly calcified wall and a thin enhancing rim compatible with a pericyst, reported as stage CE3a (WHO-IWGE), and Echinococcus IgG serology was positive. In the absence of histological confirmation, a presumptive diagnosis of splenic CE was made after considering the relevant differential diagnoses. Given the small, uncomplicated cyst and the wish to preserve splenic function, the patient was managed with continuous albendazole monotherapy (400 mg twice daily) for six months, without any invasive procedure. Treatment was well tolerated, and serial imaging showed a modest reduction in size together with evolution of the cyst content toward a solid, calcified, inactive-appearing pattern that remained stable for six months after treatment discontinuation. This case suggests that, in exceptionally selected patients, albendazole monotherapy with close imaging surveillance may allow spleen preservation; it should not be regarded as a standard alternative to surgery.