Hydatid pelvic disease of the bone is considered to be the disease of the young. Diagnosis is primarily based on the findings of X-rays and computed tomography (CT) scans [
9‐
11]. Hydatid bone disease should be considered in any differential diagnosis of osteolytic lesions, especially in endemic regions. The location is mostly hepatic (75%) and pulmonary (15%), and only 10% occur in the rest of the body. Primary skeletal involvement seldom occurs. Bone involvement is seen in only 1 to 2.5% of cases of hydatidosis [
12] and surprisingly musculoskeletal lesions of cystic echinococcosis usually occur as isolated findings and without concomitant hepatic or pulmonary involvement [
12,
13]. Nevertheless, the involvement of other organs should be ruled out in any patient with bone hydatidosis. The spine is the most common location for about 50% of osseous hydatidosis, followed by pelvis and hip, the femur, the tibia, the ribs and the scapula [
14]. Hydatid disease of bone usually remains asymptomatic over a long period, and it is usually detected after a pathological fracture or secondary infection or the onset of compressive symptoms on adjacent soft tissues. The clinical manifestation may take 10 to 20 years to become obvious, since the cyst grows very slowly. The most common radiological manifestation of skeletal hydatid disease is of a lucent expansile lesion with cortical thinning [
15]. The CT appearance of a bone lesion is a well-defined, typically multiloculated osteolytic lesion sometimes with coarse trabeculae within it, giving a honeycomb appearance, which is accompanied by expansion of the bone and thinning of its cortex [
16]. The MRI signal intensity pattern of the daughter cysts reflects their contents and may vary in cysts that are dead or alive. The production of hydatid fluid stops when they disintegrate at death [
17]. MRI is also helpful in delineating the soft tissue extent of the disease. Immunodiagnosis is useful not only in primary diagnosis but also for follow-up of patients after surgical or pharmacological treatment [
18]. Detection of circulating
Echinococcus granulosus antigens in serum is less sensitive than antibody detection, which remains the method of choice [
14]. Enzyme-linked immunosorbent assay, indirect hemagglutination antibody assay, latex agglutination test, and immunoblot test are the most commonly used immunological methods. Theoretically, surgery with a broad safety margin is the best treatment for bone hydatidosis [
19]; however, most times this recommendation is impossible. For example, in most common sites of hydatid disease of bone, spine and pelvis, radical resection of the lesion is practically impossible [
19]. Comparable data have been collected on the outcome of chemotherapy with benzimidazole carbamate (albendazole) that show encouraging results [
14]. Albendazole sulfoxide is better absorbed with higher levels of active metabolite in the cysts compared with other benzimidazoles [
14]. Treatment with albendazole is effective, but at least one cycle should be given before operation and six or more courses afterwards [
14]. In our study, our patient underwent multiple surgeries before presenting to our institute, which reflects the importance of diagnosing the disease early because delay in diagnosis and inadequate management, as happened in this case, leads to further advancement of disease and psychological stress to the patient and his or her family. The natural course of the hydatid disease was explained to our patient including the chances of recurrence of infection. She underwent wide margin excision and stabilization of proximal femur defect with free vascularized fibula along with LCP. She had a follow-up of 60 months and is infection and disease free until now.