A 56-year-old woman with ADPKD and PLD (Fig. ) and a history of hepatic cyst infection developed right lower-quadrant abdominal pain and experienced a loss of appetite. The patient had no fever. Lanreotide injections (120 mg) were started 3 months earlier. At admission, laboratory investigations revealed increased serum CRP (156 mg/L) and increased serum ALP and GGT (123 U/L and 106 U/L, respectively). Urine sediment analysis revealed leukocyturia. Under the diagnosis of hepatic cyst infection, the patient was treated with cefuroxim/metronidazole intravenously for 1 day. Blood and urine cultures remained negative. 18F-FDG PET/CT (performed 4 days after admission) showed signs of a hepatic cyst infection (Supplementary Fig. 1B). Treatment was switched to oral ciprofloxacin for another 80 days. After 3 days, the patient was discharged. Recovery was uneventful.
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.