Cryptogenic hepatitis simulating cyst rupture and hydatid jaundice in a patient with preexisting asymptomatic hydatid cyst

Rupture into the biliary ducts is the most frequent complication of hydatid liver disease. In endemic areas of Echinococcus granulosus, development of jaundice in a patient with liver cyst is initially suspected to have hydatid cyst.
A 48 year-old woman with history of asymptomatic hydatid liver cysts was admitted to the emergency department with right upper quadrant abdominal pain, increased levels of liver enzymes, bilirubin and alkaline phosphatase and the initial clinical diagnosis was the hydatid cyst rupture into the bile ducts. Surgery was planned but radiological evaluation (MRI) revealed non-dilated intra-extra biliary ducts. High suspicion of hydatid rupture required diagnostic ERCP that was normal and surgery was cancelled then. A possible diagnosis of coexistent hepatitis was suspected. Liver function tests normalized gradually and no cyst rupture was determined during surgery.
These findings suggest considering the possible development of cryptogenic hepatitis in patients with preexisting hydatid cyst.