DON’T BE SO LITTORAL: FALSE-POSITIVE ECHINOCOCCUS ANTIBODY TESTING MASKS A CASE OF LITTORAL CELL ANGIOMA D Krakosky MS 1 ; A Jang MD 1 ; R Craig MD 2 , PhD, TC Chen 3 MD, M Bangert 4 MD, David Mushatt 4 MD 1. Department of Medicine, 2. Department of Pathology, 3. Department of Neurology, 4. Section of Infectious Disease, Tulane University School of Medicine, New Orleans, LA INTRODUCTION: Littoral cell angioma (LCA) is a rare, benign, primary splenic tumor that typically presents with vague abdominal pain or is discovered incidentally. Echinococcus, on the other hand, is a well understood tapeworm that is common in endemic areas. It causes hydatid cystic disease, most commonly of the liver. CASE: A 31-year-old woman presented with bilateral upper quadrant abdominal pain associated with vomiting, cough, and chills. She had presented one week prior with complaints of diarrhea. Computed Tomography (CT) of the abdomen showed splenomegaly and she was discharged with presumed gastroenteritis. She denied recent travel or sick contacts. She was incidentally found to be positive for COVID-19 infection without hypoxia or pulmonary symptoms. A repeat CT had findings concerning for cystic splenic and hepatic abscesses. The patient was intermittently febrile to 102-1030F, and comprehensive testing for an infectious etiology came back positive for Echinococcus antibodies. Repeat testing was positive, so the patient was started on albendazole, which coincidentally led to immediate resolution of fevers. Samples sent to the Centers for Disease Control and Prevention for confirmatory Echinococcus antibody testing came back negative. After two weeks of albendazole treatment, splenectomy and left partial hepatectomy were performed, with pathology positive for littoral cell angioma of spleen and focal nodular hyperplasia of the liver. DISCUSSION: Although the pathogenesis of LCA is poorly understood, it primarily presents with vague abdominal pain and is discovered incidentally. Additionally, Echinococcus infection is also known to cause hepatic and splenic cystic disease. However, there was a low probability of this being the causative agent in this case given the lack of travel to an endemic area or other risk factors. Nonetheless, antibody tests were ordered based on the initial CT read suggestive of Echinococcus infection, and the positive test prompted an expensive course of albendazole. While this case adds to the limited literature on LCA, it also emphasizes the importance of utilizing pretest probabilities when ordering tests to both diminish costs and hasten the path to diagnoses.
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