Unexpected Abscess Localization of the Anterior Abdominal Wall in an ADPKD Patient Undergoing Hemodialysis

Abstract

Autosomal Dominant Polycystic Kidney Disease (ADPKD) is one of the most common monogenic disorders and the leading inheritable cause of end-stage renal disease worldwide. Cystic and noncystic extrarenal manifestations are correlated with variable clinical presentations so that an inherited disorder is now considered a systemic disease. Kidney and liver cystic infections are the most common infectious complications in ADPKD patients. Furthermore, it is well known that ADPKD is commonly associated with colonic diverticular disease which recently has been reported to be linked to increased risk of infection on hemodialysis patients. Herein, we present a case of anterior abdominal wall abscess caused by Enterococcus faecalis in a patient with ADPKD undergoing hemodialysis. Although the precise pathway of infection remains uncertain, the previous medical history as well as the clinical course of our patient led us to hypothesize an alternative route of infection from the gastrointestinal tract through an aberrant intestinal barrier into the bloodstream and eventually to an atypical location.

Pyonephrosis caused by Salmonella sp. in a patient with polycystic kidney disease undergoing hemodialysis

“…Patients who undergo hemodialysis are more prone to bacterial translocation, due to predisposing factors such as slow intestinal transit and heart failure [8]. The patient in this case was immunocompromised due to chronic kidney disease, a group of increased risk for this occurrence.…”

“…Complications resulting from infections in patients with PKD, especially those who are on chronic hemodialysis, are recurrent, tend to relapse and are life-threatening [8]. The cysts raise the intra-abdominal pressure and increase the permeability of the intestinal mucosa due to reduction of the blood flow in the microcirculation, therefore favouring bacterial passage through the intestinal wall [9,10].…”