A 57-year-old man with ADPKD and a limited number of hepatic cysts (Fig. ) was admitted to the hospital because of fever (39.8 °C), right-sided flank pain, diarrhea, vomiting, and headache. Lanreotide injections (120 mg) were started 19 months earlier. At admission, serum CRP was elevated (131 mg/L) and liver enzymes were not elevated (AST 23 U/L, ALT 22 U/L, ALP 71 U/L, GGT 35 U/L). Leukocyturia was excluded. A chest radiograph and abdominal ultrasound were unremarkable. Blood cultures grew E. coli, whereas urine cultures were negative. Under the suspicion of hepatic cyst infection, the patient was hospitalized and treatment with ceftriaxone intravenously was initiated by the local physicians. At discharge, after 3 days, treatment was switched to oral ciprofloxacin for a total of 7 weeks. Recovery was uneventful.\nThe time between injection and development of cyst infection differed widely between patients (1–21 days). The number of days between injection and cyst infection for the individual cases was: 16 (case 1 episode 1) 21 (case 1 episode 2), 8 (case 2), 9 (case 3), 8 (case 4), 16 (case 5), 11 (case 6), and 1 (case 7). It was not documented whether microbiologists were involved in the management of liver cyst infections and whether antibiotic susceptibilities were performed.
A 49-year-old woman with ADPKD and PLD (Fig. ) was referred to the hospital because of upper abdominal pain, fever (38.3 °C) with cold shivers and diarrhea. Lanreotide injections (120 mg) were started 2 months earlier. Because of complaints of bradycardia and hypotension, the lanreotide dose was adjusted to 90 mg after the first injection. At admission, serum CRP was 105 mg/L, with elevated ALP (150 U/L) and GGT (230 U/L). Urine sediment analysis revealed leukocyturia. During admission, a chest radiograph and abdominal ultrasound did not show abnormalities, whereas a magnetic resonance imaging scan showed an image of renal cyst hemorrhage in both kidneys. Under the suspicion of hepatic cyst infection, the patient was treated with oral ciprofloxacin. Urine and blood cultures remained negative. Hospitalisation lasted 5 days, and in total ciprofloxacin was given during 42 days. Recovery was uneventful.