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 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.