Infected Liver Cysts in PKD Patient

Dear Ask The Doctor: My wife, a pkd patient,had her successful Kidney transplant in 2007. In Oct.2009,she developed infection in her liver cysts.She was admitted in top 3-4 hospitals in India and received various antibiotic I.V.course,Last was from CMC,Vellore.They prescribed Meropenem TDS for 8 weeks,which we completed by Feb.20th 2010.But after 15 days of the course completion,symptoms like fever and abdominal pain resurfaced!Blood culture from all hospitals was sterile,but she responded well with Meropenem. Can any expert in your portal give us helpful advice to avoid Liver transplant, the only option left out according to specialists!

Dear Lilly: Blood cultures will often be negative or sterile if there has been previous antibiotic exposure or incomplete courses of antibiotics. If your wife is spiking temperatures while on antibiotic therapy, this treatment is not effective and should be discontinued or an alternative prescribed. It is difficult to comment due to limited information on your wife’s complex case. Polycystic liver disease can be associated with polycystic kidney disease and often leads to nodular enlargement of the liver. I would advise referral to a hepatologist in your wife’s complex case. They may suggest aspiration of an individual liver cyst through CT/ultrasound guidance, and trying to culture or view an organism under the microscope, and therefore tailoring antibiotic medication accordingly. Post procedure bleeding into a cyst is a risk. Transplantation is an option for Polycystic Liver Disease with reports of dramatic improvement in quality of life and acceptable morbidity. However I would discuss this with a hepatologist or transplant team to calculate the risks and benefits in your wife’s case.