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Otto W, Psomiadis JS, Kirshner B. Management of a Suspected Renal Cyst Infection With Intracystic Hemorrhage in a Patient With Autosomal Dominant Polycystic Kidney Disease. Cureus 2023; 15:e39319. [PMID: 37351251 PMCID: PMC10282502 DOI: 10.7759/cureus.39319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 06/24/2023] Open
Abstract
Renal cyst infections are a serious complication in patients with autosomal dominant polycystic kidney disease (ADPKD). Cyst infections are challenging to treat and have a high incidence of complications such as sepsis and death. No guideline or evidence-based strategy for diagnosis or treatment of cyst infection currently exists. This lack of standardized guidance leads to individualized medical decision-making for each individual case, despite the high risk of morbidity and mortality associated with the infection. This case describes a 33-year-old female with a past medical history of ADPKD that presented with hematuria, increased urinary frequency, and left flank pain. On computed tomography (CT) imaging, she was found to have a large intracystic hemorrhage with an associated hematoma formation. Laboratory evaluation was remarkable for leukocytosis with left shift but normal renal function. Urinalysis displayed hematuria and the presence of protein, but the culture resulted in no growth. In the presence of clinical signs of infection, she was suspected to have an infected renal cyst that did not have glomerular communication, given the bland urinalysis and negative urine culture. Her hemoglobin stabilized, and she did not require embolization or percutaneous drainage of the cyst. Intravenous levofloxacin was initiated, and the patient clinically improved with the normalization of leukocytosis. Blood cultures remained negative, and she was discharged to home with a course of oral levofloxacin with a resolution of symptoms.
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Affiliation(s)
- Whitnee Otto
- Internal Medicine, Piedmont Macon Medical Center, Macon, USA
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Pijl JP, Kwee TC, Slart RHJA, Glaudemans AWJM. PET/CT Imaging for Personalized Management of Infectious Diseases. J Pers Med 2021; 11:jpm11020133. [PMID: 33669375 PMCID: PMC7920259 DOI: 10.3390/jpm11020133] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 12/28/2022] Open
Abstract
Positron emission tomography combined with computed tomography (PET/CT) is a nuclear imaging technique which is increasingly being used in infectious diseases. Because infection foci often consume more glucose than surrounding tissue, most infections can be diagnosed with PET/CT using 2-deoxy-2-[18F]fluoro-D-glucose (FDG), an analogue of glucose labeled with Fluorine-18. In this review, we discuss common infectious diseases in which FDG-PET/CT is currently applied including bloodstream infection of unknown origin, infective endocarditis, vascular graft infection, spondylodiscitis, and cyst infections. Next, we highlight the latest developments within the field of PET/CT, including total body PET/CT, use of novel PET radiotracers, and potential future applications of PET/CT that will likely lead to increased capabilities for patient-tailored treatment of infectious diseases.
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Affiliation(s)
- Jordy P. Pijl
- Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, 9700 RB Groningen, The Netherlands; (T.C.K.); (R.H.J.A.S.); (A.W.J.M.G.)
- Correspondence: ; Tel.: +31-50-361-6161
| | - Thomas C. Kwee
- Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, 9700 RB Groningen, The Netherlands; (T.C.K.); (R.H.J.A.S.); (A.W.J.M.G.)
| | - Riemer H. J. A. Slart
- Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, 9700 RB Groningen, The Netherlands; (T.C.K.); (R.H.J.A.S.); (A.W.J.M.G.)
- Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, 7500 AE Enschede, The Netherlands
| | - Andor W. J. M. Glaudemans
- Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, 9700 RB Groningen, The Netherlands; (T.C.K.); (R.H.J.A.S.); (A.W.J.M.G.)
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Suwabe T, Oguro M, Ubara Y, Ikuma D, Mizuno H, Hayami N, Yamanouchi M, Sawa N. Repetitive Refractory Renal Cyst Infection in Autosomal Dominant Polycystic Kidney Disease for which Renal Transcatheter Arterial Embolization Was Effective in Preventing Recurrence. Intern Med 2021; 60:3261-3265. [PMID: 34657906 PMCID: PMC8580762 DOI: 10.2169/internalmedicine.6974-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Renal cyst infection is a frequent and serious complication of autosomal dominant polycystic kidney disease (ADPKD) that is often difficult to treat and can be fatal. While nephrectomy is the standard therapy for severe refractory renal cyst infection, it can be associated with severe adverse events. We experienced a case of repetitive renal cyst infection in a 58-year-old Japanese man with ADPKD on dialysis. He underwent renal transcatheter arterial embolization (TAE) four months after the last episodes of renal cyst infection, and his renal cyst infection has not recurred since renal TAE. This case suggested that renal TAE is effective for preventing repetitive renal cyst infection.
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Affiliation(s)
- Tatsuya Suwabe
- Department of Nephrology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Masahiko Oguro
- Department of Nephrology, Toranomon Hospital Kajigaya, Japan
| | - Yoshifumi Ubara
- Department of Nephrology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Daisuke Ikuma
- Department of Nephrology, Toranomon Hospital Kajigaya, Japan
| | - Hiroki Mizuno
- Department of Nephrology, Toranomon Hospital Kajigaya, Japan
| | - Noriko Hayami
- Department of Nephrology, Toranomon Hospital Kajigaya, Japan
| | | | - Naoki Sawa
- Department of Nephrology, Toranomon Hospital Kajigaya, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
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Yokoyama H, Sakaguchi M, Yamada Y, Kitamoto K, Okada S, Kanzaki S, Namba N. Successful Treatment of Cyst Infection in an Infant With Autosomal Dominant Polycystic Kidney Disease Using Trimethoprim/Sulfamethoxazole. Front Pediatr 2020; 8:216. [PMID: 32582581 PMCID: PMC7280440 DOI: 10.3389/fped.2020.00216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/14/2020] [Indexed: 01/13/2023] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic disease causing renal cysts. Reports on kidney cyst infection in children are rare despite cyst infections being important complications of ADPKD. Here, we report a case of a child without any medical history who had a urinary tract infection with sepsis at 7 months. Leukocyturia persisted despite antibiotic therapy because the infection was treatment-resistant. Initial ultrasound and contrast computed tomography were inconclusive because cysts could not be detected clearly, and a family history of renal cysts was not determined. Subsequently, history of paternal renal cysts, thick walls in infectious cystic lesions on diffusion-weighted magnetic resonance imaging (MRI), and multiple small lesions with high signals on T2-weighted imaging in both kidneys became apparent. Upon diagnosis of ADPKD with cyst infection, antibiotic therapy was switched from cefotaxime to trimethoprim/sulfamethoxazole to achieve better cyst penetration, which successfully resolved the infection. In this patient, MRI was effective for clear visualization and diagnosis of infectious lesions and small cysts in undiagnosed ADPKD with cyst infection. Administering antibiotics with better cyst penetration is important. Trimethoprim/sulfamethoxazole is an option for use in children. This is the first case report that describes ADPKD with cyst infection in an infant in detail.
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Affiliation(s)
- Hiroki Yokoyama
- Division of Pediatrics and Perinatology, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Mayumi Sakaguchi
- Department of Pediatrics, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Yuko Yamada
- Division of Pediatrics and Perinatology, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Koichi Kitamoto
- Division of Pediatrics and Perinatology, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Shinichi Okada
- Division of Pediatrics and Perinatology, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Susumu Kanzaki
- Asahigawaso Rehabilitation and Medical Center, Okayama, Japan
| | - Noriyuki Namba
- Division of Pediatrics and Perinatology, Faculty of Medicine, Tottori University, Yonago, Japan
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Yasuda I, Hasegawa K, Tokuyama H, Washida N, Shinozuka K, Yasuda M, Ryuzaki M, Urai H, Wakino S, Itoh H. A Case Report of Autosomal Dominant Polycystic Kidney Disease Under Peritoneal Dialysis With Cyst Infection and Culture-Positive Peritoneal Fluid. Clin Med Insights Case Rep 2019; 12:1179547619846860. [PMID: 31065220 PMCID: PMC6488781 DOI: 10.1177/1179547619846860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 03/21/2019] [Indexed: 01/14/2023]
Abstract
Background: Cyst infection is a complication sometimes seen in patients with autosomal
dominant polycystic kidney disease (ADPKD) and often shows through a
positive blood culture. However, there have been no reports of ADPKD
patients whose cyst infection propagate to peritoneal fluid leading to
positive peritoneal fluid culture. Case presentation: A 74-year-old Japanese man with ADPKD under peritoneal dialysis (PD) was
presented with left flank pain, fever, and chills at our hospital. He did
not show any symptoms or signs suggestive of peritonitis. There were no
elevated cell counts or polymorphonuclear leucocytes in his PD fluid. There
were some complicated cysts found in computed tomography and magnetic
resonance imaging examinations. We clinically diagnosed him as having a
renal cyst infection rather than PD-related peritonitis. We initiated
treatment by administering ceftriaxone with an immediate favorable response.
As the possibility of accompanying prostatitis still remained, we switched
to intravenous levofloxacin on the second day. On the 10th day,
Helicobacter cinaedi was detected in 2 sets of blood
culture as well as in PD fluid. We switched back to ceftriaxone and this
treatment was entirely successful. Conclusions: This is the first report of H cinaedi cyst infection which
propagates to peritoneal fluid in a patient with ADPKD.
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Affiliation(s)
- Itaru Yasuda
- Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Kazuhiro Hasegawa
- Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Hirobumi Tokuyama
- Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Naoki Washida
- Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan.,Department of Nephrology, School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Keisuke Shinozuka
- Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Marie Yasuda
- Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Masaki Ryuzaki
- Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Hidenori Urai
- Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Shu Wakino
- Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Hiroshi Itoh
- Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
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Lantinga MA, Casteleijn NF, Geudens A, de Sévaux RGL, van Assen S, Leliveld AM, Gansevoort RT, Drenth JPH. Management of renal cyst infection in patients with autosomal dominant polycystic kidney disease: a systematic review. Nephrol Dial Transplant 2017; 32:144-150. [PMID: 26908766 DOI: 10.1093/ndt/gfv452] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 12/17/2015] [Indexed: 01/19/2023] Open
Abstract
Background Renal cyst infection is one of the complications faced by patients with autosomal dominant polycystic kidney disease (ADPKD). Cyst infection is often difficult to treat and potentially leads to sepsis and death. No evidence-based treatment strategy exists. We therefore performed a systematic review to develop an effective approach for the management of renal cyst infection in ADPKD patients based on the literature. Methods A systematic search was performed in PubMed (January 1948-February 2014), EMBASE (January 1974-February 2014) and the Cochrane Library (until February 2014) according to the PRISMA guidelines. Results We identified 60 manuscripts that included 85 ADPKD patients with renal cyst infection (aged 52 ± 12 years, 45% male, 27% on dialysis, 13% history of renal transplantation and 6% diabetes mellitus). Included patients received a total of 160 treatments of which 92 were antimicrobial, 29 percutaneous and 39 surgical. Initial management often consisted of antimicrobials (79%), and quinolone-based regimens were favoured (34%). Overall, 61% of patients failed initial treatment, but treatment failure has decreased over time (before the year 2000: 75%; during and after the year 2000: 51%, P = 0.03). Post-renal obstruction, urolithiasis, atypical or resistant pathogens, short duration of antimicrobial treatment and renal function impairment were documented in patients failing treatment. Conclusions First-line treatment of renal cyst infection in ADPKD consists of antimicrobials and is associated with a high rate of failure, but treatment success has increased over recent years. A large-scale unbiased registry is needed to define the optimal strategy for renal cyst infection management in ADPKD.
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Affiliation(s)
- Marten A Lantinga
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Niek F Casteleijn
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Alix Geudens
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ruud G L de Sévaux
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sander van Assen
- Department of Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anna M Leliveld
- Department of Urology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ron T Gansevoort
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
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Casillas-Sagrado E, Burguera V, Rioja-Martín ME, Rivera-Gorrín M. Infected renal cyst presented with pleural effusion in a woman with autosomal dominant polycystic kidney disease. Clin Kidney J 2017; 11:204-206. [PMID: 29644060 PMCID: PMC5888413 DOI: 10.1093/ckj/sfx098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/03/2017] [Indexed: 01/24/2023] Open
Abstract
We present a 64-year-old woman with autosomal dominant polycystic kidney disease and hepatic cysts admitted to our hospital for high fever, intense coughing and right abdominal pain. The chest X-ray showed right pleural effusion suggestive of pneumonia. An abdominal ultrasound and computed tomography (CT) were done but did not show evidence of cyst infection or other abdominal complications. A gallium-67-citrate single-photon emission CT/CT, a relatively cheaper technique than positron emission tomography/CT was performed. This revealed an infected kidney cyst that was the cause of the right pleural effusion and fever.
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Affiliation(s)
| | - Victor Burguera
- Department of Nephrology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | | | - Maite Rivera-Gorrín
- Department of Nephrology, Hospital Universitario Ramon y Cajal, Madrid, Spain
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Tamigniau A, Vanhaecke J, Saegeman V. Cronobacter sakazakii bacteremia in a heart transplant patient with polycystic kidney disease. Transpl Infect Dis 2015; 17:921-5. [PMID: 26436411 DOI: 10.1111/tid.12466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/01/2015] [Accepted: 09/06/2015] [Indexed: 11/27/2022]
Abstract
Infections with Cronobacter sakazakii are mainly described among neonates and infants, with contaminated powdered infant formulas most often incriminated as the cause. We describe here a case of C. sakazakii bacteremia secondary to a suspected cyst infection in a heart-and-kidney transplant patient with polycystic kidney disease.
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Affiliation(s)
- A Tamigniau
- Department of Laboratory Medicine, UZ Leuven, Leuven, Belgium
| | - J Vanhaecke
- Cardiology, Department of Cardiovascular Sciences, UZ Leuven, Leuven, Belgium
| | - V Saegeman
- Department of Laboratory Medicine, UZ Leuven, Leuven, Belgium
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Schipper HG, Laméris JS, van Delden OM, Rauws EA, Kager PA. Percutaneous evacuation (PEVAC) of multivesicular echinococcal cysts with or without cystobiliary fistulas which contain non-drainable material: first results of a modified PAIR method. Gut 2002; 50:718-23. [PMID: 11950823 PMCID: PMC1773202 DOI: 10.1136/gut.50.5.718] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Surgery is the treatment of choice in echinococcal cysts with cystobiliary fistulas. PAIR (puncture, aspiration, injection, and reaspiration of scolecidals) is contraindicated in these cases. AIM To evaluate a modified PAIR method for percutaneous treatment of multivesicular echinococcal cysts with or without cystobiliary fistulas which contain non-drainable material. PATIENTS Twelve patients were treated: 10 patients with multivesicular cysts which contained non-drainable material and were complicated by spontaneous intrabiliary rupture, secondary cystobiliary fistulas, cyst infection, or obstructed portal or hepatic veins; and two patients with large univesicular cysts and a ruptured laminated membrane, one obstructing the portal and hepatic veins and one a suspected cystobiliary fistula. METHODS The methods used, termed PEVAC (percutaneous evacuation of cyst content), involved the following steps: ultrasound guided cyst puncture and aspiration of cyst fluid to release intracystic pressure and thereby to avoid leakage; insertion of a large bore catheter; aspiration and evacuation of daughter cysts and endocyst by injection and reaspiration of isotonic saline; cystography; injection of scolecidals only if no cystobiliary fistula was present; external drainage of cystobiliary fistulas combined with endoprosthesis or sphincterotomy; catheter removal after complete cyst collapse and closure of the cystobiliary fistula. RESULTS In all 12 patients initial cyst size was 13.1 (6-20) cm (mean (range)). At follow up 17.9 (4-30) months after PEVAC, seven cysts had disappeared and five cysts had decreased to 2.4 (1-4) cm (p=0.002). In eight patients with multivesicular cysts, a cystobiliary fistula, and infection, cyst size was 12.5 (6-20) cm, catheter time 72.3 (28-128) days, and hospital stay 38.1 (20-55) days. At 17.3 (4-28) months of follow up, six cysts had disappeared and in two cysts residual size was 1 and 2.9 cm, respectively (p=0.012). In four patients without a cystobiliary fistula, cyst size was 14.4 (12.7-16) cm, catheter time 8.8 (3-13) days, and hospital stay 11.5 (8-14) days. At 19.3 (9-30) months of follow up, one cyst had disappeared and three cysts were 85 (69-94)% smaller (2.2 (1-4) cm) (p=0.068). CONCLUSION PEVAC is a safe and effective method for percutaneous treatment of multivesicular echinococcal cysts with or without cystobiliary fistulas which contain non-drainable material.
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Affiliation(s)
- H G Schipper
- Department of Infectious Diseases, Tropical Medicine, and AIDS, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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