A 51-year-old woman with ADPKD and PLD (Fig. ) presented at the hospital because of right upper-quadrant abdominal pain, fever (38 °C), nausea, and vomiting. Lanreotide treatment (120 mg) was started 5 months earlier. At admission, serum CRP was 329 mg/L and serum liver enzymes were normal (AST 29 U/L, ALT 27 U/L, ALP 57 U/L, and GGT 39 U/L). Local physicians initiated piperacillin/tazobactam intravenously under the suspicion of hepatic cyst infection. Blood cultures grew E. coli. Abdominal CT at admission showed no sign of hepatic cyst infection. Patient was hospitalized for 3 days. Treatment was switched to ciprofloxacin twice daily at discharge and continued for 2 weeks. 18F-FDG PET/CT was performed 3 days after discharge and revealed two hepatic cysts showing signs of infection. 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.