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A 68-year-old woman, affected by autosomal dominant polycystic liver and kidney disease (ADPKD), seeks nephrological attention for persistent low-grade fever, with vague abdominal discomfort. She reports a recent gastroenteritis episode, followed by a lower urinary tract infection (Escherichia coli), treated by amoxicillin clavulanate on the basis of the antibiogram. Afterwards, she developed a severe cutaneous allergy, which she linked to amoxicillin clavulanate. On account of the persistence of a low-grade fever, she self-prescribed different antibiotics, without complete clinical remission.  At referral, the patient is pale and normotensive with diffuse abdominal tenderness. Her main blood tests are as follows: WBC 9330/mm3, serum creatinine 0.9 mg/dL, GFR 65 mL/min, C-reactive protein 2.38 mg/dL (normal <0.8), ESR 21 mm/h, Hb 10.3 g/dL, serum albumin 2.9 g/dL and 6–8 WBC per high power field at urinalysis. Renal ultrasounds reveal enlarged liver and kidneys with large cysts (maximum 6 cm bilaterally). A complicated cyst, containing dense fluid material (caused by infection or bleeding), is located in the left kidney.

Positron emission tomography: a precious tool in the challenge of the infected cysts in ADPKD