PDF(Pubmed)
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.
摘要：
肾囊肿感染是常染色体显性遗传性多囊肾病（ADPKD）患者的严重并发症。囊肿感染的治疗具有挑战性，并且具有高发生率的并发症，例如败血症和死亡。目前尚无诊断或治疗囊肿感染的指南或循证策略。这种缺乏标准化指导导致每个个案的个体化医疗决策,尽管与感染相关的发病率和死亡率很高。该病例描述了一名33岁的女性，其既往有ADPKD病史，并伴有血尿，尿频增加,和左腹疼痛。计算机断层扫描（CT）成像，她被发现有大量的囊内出血和相关的血肿形成。实验室评估对左移但肾功能正常的白细胞增多非常重要。尿液分析显示血尿和蛋白质的存在，但是文化没有增长。在存在感染的临床症状的情况下，她被怀疑患有感染的肾囊肿，没有肾小球通讯，考虑到平淡的尿液分析和阴性的尿液培养。她的血红蛋白稳定下来,她不需要栓塞或经皮引流囊肿。开始静脉注射左氧氟沙星，随着白细胞增多的正常化，患者的临床症状得到改善。血培养保持阴性,她出院回家，口服了一个疗程的左氧氟沙星，症状得到缓解。
