Background:
Echinococcosis is a zoonotic infection caused by tapeworms of the genus Echinococcus. Geographic provenance is often used to guide species attribution, but may be misleading in patients who have migrated into endemic areas.

Case presentation:
A cystic hepatic lesion was discovered in a migrant from Eritrea, residing in Germany for 8 years. Imaging studies (Ultrasound, CT, MRI, PET-CT) demonstrated a polycystic structure in the right lobe. Serology was positive for Echinococcus (without species differentiation). Based on the patient's origin and imaging morphology, cystic echinococcosis caused by E. granulosus was initially assumed. After initiating albendazole therapy, hemihepatectomy was performed. Unexpectedly, molecular analysis demonstrated >99% concordance with E. multilocularis, confirming a diagnosis of alveolar echinococcosis (AE) acquired in Germany.

Conclusion:
Migrants may acquire endemic zoonoses including AE in Central Europe, assumptions based on geographic origin may thus be misleading. Molecular species confirmation is helpful when imaging and serology do not unequivocally differentiate Echinococcus species.