Atypical alveolar echinococcosis with systemic involvement in a patient treated with dupilumab

Introduction. - Alveolar echinococcosis is an endemic parasitic disease prevalent in certain cold regions of the Northern Hemisphere, including Eastern France, Switzerland, Germany, Canada, and the United States. Widely underdiagnosed, it is associated with infection by Echinococcus multilocularis , a small tapeworm belonging to the cestode class, capable of causing multi -systemic involvement, particularly in elderly or immunocompromised patients. Case report. - We present the case of an 82 -year -old patient, immunocompromised due to prolonged corticosteroid therapy and treatment with dupilumab. She was referred to our department for a diagnostic assessment of atypical hepatic and pulmonary lesions, initially suspected of tuberculosis or an IgG4related disease. The hypothesis of alveolar echinococcosis caused by E. multilocularis was eventually considered based on a set of arguments, further confirmed by molecular diagnosis. We discuss the role of dupilumab in the systemic evolution and atypical presentation of the disease, through the induction of a specific immunosuppression. Conclusion. - Alveolar echinococcosis should be systematically considered in case of systemic disease with prominent hepatic and pulmonary involvement, especially in immunocompromised patients. (c) 2024 The Author(s). Published by Elsevier Masson SAS on behalf of Soci & eacute;t & eacute; Nationale Franc , aise de M & eacute;decine Interne (SNFMI). This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).