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 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.