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.