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.
A 55-year-old woman with ADPKD and PLD (Fig. ) and a history of a hepatic cyst infection (6 months and 1 year prior to the current event) developed fever (38.9 °C) and right upper-quadrant abdominal pain during a stay abroad. Lanreotide treatment (120 mg) was started 2 months earlier. She was hospitalized in a foreign country. At admission, serum CRP and liver enzymes were not determined, but serum white blood cell count was 9.0 × 10e9/L. Liver enzymes on day 4 after admission were not raised (AST 17 U/L, ALT 19 U/L, ALP 52 U/L, and GGT 39 U/L). A chest radiograph and abdominal ultrasound (performed on the day of admission and 1 day after, respectively) were unremarkable. A chest radiograph was repeated on the second day of admission and showed right-sided abnormalities compatible with either atelectasis or pneumonia. In contrast, 18F-FDG PET/CT (performed 3 days after admission) was unremarkable. All blood cultures were negative. Under the suspicion of hepatic cyst infection, the patient was hospitalized for 4 days and treated by local physicians with intravenous ampicillin-tazobactam, vancomycin, and meropenem. This was followed by oral amoxicillin/clavulanic acid for a total of 90 days. Recovery was uneventful.