Albendazole Induced Easy Bruising in a Patient of Hydatid Cyst of Liver.

Sir,

Hydatid cyst, also known as echinococcosis, is the most common hepatic cyst throughout the world.[1] It is caused by larval stage of Echinococcus granulosus.[2] Humans are accidental hosts with dogs and wolves being the primary hosts. Hydatid cysts may develop anywhere in the body, but liver is the most common site involved followed by lung.[2] The disease is mostly asymptomatic and may be found accidentally on investigation such as abdominal ultrasound. One of the serious complications includes rupture of the cyst into the peritoneal cavity which may lead to anaphylaxis and death. While complications may require emergent surgical intervention, less severe cases have been managed successfully with oral albendazole since the 1980s. Albendazole and its metabolites reach high concentrations in the hydatid fluid and cause death of the parasite by attacking its germinal layer.[34] Here, we report a middle-aged female patient with diagnosed case of Echinococcus multilocularis who had been receiving oral albendazole 400 mg daily for the past 2 months, suddenly developed bruising over her left thigh [Figures 1 and 2]. She did not give any history of trauma. All the investigations including complete hemogram and coagulation profile were within normal limits, except erythrocyte sedimentation rate which was found to be 42 mm/h by Westergren method. The bruises used to heal spontaneously, but recurrence was noted. This recurrent and easy pattern of bruising was attributed to intake of albendazole. Albendazole has been known to cause easy bruising with single dosage, but in this case, it was attributed to the daily administration of 400 mg of albendazole continuously for 2 months. The patient was put on oral tablet Vitamin C 500 mg twice a day and no recurrence was seen after that. Through this letter, we want to draw attention to the fact that most people tend to ignore symptoms such as bruising and which is commonly thought to be caused by trauma. However, in the absence of any trauma, a thorough examination should be conducted and all the investigations should be done to rule out other severe causes of bruising. In our case, albendazole was the triggering factor, and even though this side effect is rare, it should always be kept in mind as a causative factor while examining such patients.

Figure 1

Ill-defined bruises over the left thigh

Figure 2

Multiple cystic cavities in the right hepatic lobe on ultrasound

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