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.
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.