• Mathias Friebe, Christina Große Düweler, and Sarah Theurer.
• Zentrale Notaufnahme, Evangelisches Krankenhaus Oberhausen.
• Dtsch. Med. Wochenschr. 2020 Sep 1; 145 (18): 1321-1324.

History And Clinical FindingsWe report the case of a 27-year-old Syrian patient who came to the emergency department with a syncopal episode. No medical history could be raised due to a language barrier and so the clinical presentation was leading.Investigations And DiagnosisThe patient exhibited signs of shock, accompanied by an exanthema as well as perioral hematin. In an ultrasound sonography free intraabdominal fluid and an obscure change in the upper abdomen could be visualized. An esophagogastroduodenoscopy showed evidence of an ulcer, however did not explain all symptoms. In a CT abdomen, signs of a ruptured cyst could be demonstrated.Treatment And CourseThe patient stabilized under the treatment protocol for anaphylaxis. Due to the clinical course and country of origin the patient received albendazole and a partial liver resection for a suspected echinococcus cyst.ConclusionObscure clinical symptoms alongside signs of shock, should always considered to be an allergic reaction in absence of sepsis or hemorrhage. In anaphylaxis, echinococcosis should always be included in the differential diagnosis.© Georg Thieme Verlag KG Stuttgart · New York.

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