Emphysematous cyst infection in polycystic kidney disease: a
The present case has been reported in the Indian Journal of Nephrology.

A 38-year-old non-diabetic female, a known case of autosomal dominant polycystic kidney disease (ADPKD) for the past 1 year, with history of fever and right-sided flank pain for 1 month. Family history was significant as her father also had ADPKD and expired at the age of 50 years due to advanced renal failure.

Examination revealed bilateral nodular abdominal masses with localized tenderness over the right flank. Investigations revealed neutrophilic leukocytosis with total leukocyte count of 15,000 (80% polymorphs), and urinalysis showed 40–50 pus cells per high-power field with a serum creatinine of 2.7 mg/dL. Blood and urine cultures were sterile. Ultrasonography of the abdomen revealed bilateral enlarged kidneys with multiple cysts.

Subsequently, contrast-enhanced computed tomography of the abdomen revealed bilateral polycystic kidneys with gas formation in the right polar cyst. The patient was empirically started on intravenous antibiotic piperacillin tazobactam on day 1 of hospitalization. Subsequently, she underwent cyst aspiration and percutaneous drainage of the cyst through pigtail catheter.

Cyst fluid analysis revealed numerous pus cells and culture grew Escherichia More Details coli sensitive to piperacillin tazobactam. The patient improved symptomatically, and pigtail was removed after 5 days when the drainage subsided. The antibiotic was continued for 6 weeks, and serum creatinine decreased to 1.5 mg/dL after 6 weeks of follow-up.

Clinical pearls:-
- IV antibiotic therapy alone may be insufficient to resolve emphysematous cyst infection considering disease severity and poor prognosis.

- A percutaneous cystostomy drainage and intracystic antibiotic irrigation may be one as the alternative therapeutic options to control emphysematous cyst infection instead of nephrectomy in patients with ADPKD.

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