Case
A 73-year-old female with acromegaly who had been treated with
octreotide after transsphenoidal surgery was referred for fever and
malaise. Blood tests showed leukocytosis (14,750/µL) with a high serum
level of C-reactive protein (7.29 mg/dL). Serum growth hormone (GH) and
insulin-like growth factor (IGF)-I levels were increased to 3.9 ng/mL
and 239 ng/mL, respectively. Enhanced CT revealed enlarged left renal
cysts with perinephric panniculitis, indicating infectious cysts
(Figure ). Klebsiella pneumoniae was detected from
a punctatum of the enlarged cysts and percutaneous drainage with oral
levofloxacin was effective.
Acromegaly is often complicated with cystic formation due to excessive
GH. Renal cysts are likely to develop in acromegaly, being detected in
one third of patients, particularly in elderly patients and patients
with a smoking habit who have high GH1. Simple cysts
are mostly asymptomatic; however, intractable urinary infection can
occur in developed cysts2. Attention must be paid to
unexpected infection of acromegalic renal cysts in elderly patients.