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 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.