Gluteal muscles primary hydatid cyst after cortical bone destruction in the sacrum

Hydatid disease is caused by infection of Echinococcus Granulosus. Usually Hydatid Cysts occur in the liver and lungs. Presenting hydatid cysts in bone without hepatic affectation is rare and occurs in 0.5–2% of cases. Hence, this rare case makes the diagnosis difficult for the clinicians and, as a result, misdiagnosis of sacral Echinococcosis is common. The authors report on a 47-year male with primary sacral hydatidosis and 34 years of recurrence. He was admitted with compressive neurological symptoms like tingling pain, numbness, sciatica and foot drop. He has undergone 8 operations and has been treated with Albendazole. He has developed a Sacro-cutaneous fistula. When assessing sciatica, low back pain or lower limb weakness the pelvic cavity should be examined for hidden disease that might explain the neurological symptoms. A missed diagnosis of osseous Hydatidosis could be devastating. Accordingly, the sacral Hydatid cyst must be included as a differential diagnosis for compressive neurological symptoms. In clinical practice, surgery remains the gold standard for treating osseous Hydatidosis. •The symptoms of osseous echinococcosis are non-specific and widely variable.•Sacral hydatid cyst it should be included in the differential diagnosis of any bone mass caused compressive neurological symptoms.•Treatment of hydatid cyst is primarily surgical, demanding total removal without rupture.•Posterior approach is preferred over anterior due to feasibility of the intervention and decrease of the recurrence rate.