Management of a Suspected Renal Cyst Infection With Intracystic Hemorrhage in a Patient With Autosomal Dominant Polycystic Kidney Disease

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.