Ihara Katsuhito, Naito Shotaro, Yamaguchi Wakaba, Mori Yutaro, Toda Takayuki, Rai Tatemitsu, Uchida Shinichi, Sasaki Sei, Matsui Noriaki
Department of Nephrology, Tsuchiura Kyodo General Hospital, Japan.
Intern Med. 2014;53(12):1355-9. doi: 10.2169/internalmedicine.53.1945. Epub 2014 Jun 15.
A 64-year-old Japanese man with renal dysfunction caused by autosomal dominant polycystic kidney disease (ADPKD) was admitted to our hospital for evaluation of right back pain, fever, inflammation, and pleural effusion. Diagnostic investigations for tuberculous pleuritis were all negative. Although no radiographic abnormality suggesting hepatic cyst infection was detected by computed tomography, hepatic cyst drainage demonstrated purulent contents indicative of cyst infection. Conglutination of the cyst by minocycline 100 mg was performed five times in addition to drainage. After drainage, the symptoms of inflammation, right back pain and right pleural effusion subsided. Renal function and anemia, which had been resistant to darbepoetin treatment, also improved after the procedure. These results suggested that the infected hepatic cyst was associated with the patient's symptoms, exacerbation of renal dysfunction and anemia. The pleural effusion was due to the propagation of inflammation from the cyst infection. This is the first report of an infected hepatic cyst in an ADPKD patient presenting with and diagnosed by right pleural effusion.
一名64岁的日本男性，因常染色体显性遗传性多囊肾病（ADPKD）导致肾功能不全，因右侧背痛、发热、炎症及胸腔积液入我院评估。结核性胸膜炎的诊断性检查均为阴性。尽管计算机断层扫描未发现提示肝囊肿感染的影像学异常，但肝囊肿引流显示有脓性内容物，提示囊肿感染。除引流外，还使用100毫克米诺环素对囊肿进行了5次粘连治疗。引流后，炎症、右侧背痛和右侧胸腔积液症状消退。对促红细胞生成素治疗耐药的肾功能和贫血在该治疗后也有所改善。这些结果表明，感染的肝囊肿与患者的症状、肾功能不全和贫血加重有关。胸腔积液是由于囊肿感染炎症蔓延所致。这是首例以右侧胸腔积液为表现并经诊断的ADPKD患者感染性肝囊肿的报告。
