Table 1.

Characterization of eight hepatic cyst infection episodes in seven patients during the DIPAK-1 Study

Case (episode)	Age (years)/sex	Lanreo-tide treat-ment (months) and dosage (mg)	Cyst infec-tion history	Clinical findings	Maximum serum CRP (mg/L)	Liver panel	Additional investigations	Cyst infection treatment	Antibiotic treatment duration (days)	Hospital admission (days)
1 (1)	46/M	3, 120	No	Fever (38.7 °C) RUQ abdominal pain Mild diarrhea	584↑	AST 37 ALT 32 ALP 69 GGT 50 Bili 10 (tot)	Imaging Chest radiograph/ USG-abdomen/MRI-abdomen: unremarkable 18F-FDG PET/CT: two hepatic cysts showing signs of infection Cultures Urine: negative Blood: E. coli Cyst aspirate: pus, no pathogen isolated	Antibiotic Cefuroxime 750 mg/metronidazole 500 mg, three times daily (2 days) i.v. gentamicin 300 mg bolus (three times in 1 week) Ciprofloxacin 500 mg twice daily (44 days) Amoxicillin 500 mg/clavulanic acid 125 mg (20 days) Invasive Cyst aspiration of hepatic cyst in liver segment VIII (day 9) and of hepatic cyst in liver segment VI (day 14)	48	30
1 (2)	46/M	5, 120	Yes, case 1	Fever (38.9 °C) RUQ abdominal pain	190↑	N/A	Imaging MRI-abdomen: unremarkable Cultures Urine: negative Blood: negative	Antibiotic i.v. ceftriaxone 2000 mg once daily (5 days) Ciprofloxacin 500 mg twice daily (13 days)	20	6
2	51/F	5, 120	No	RUQ abdominal pain Nausea Vomiting Fever (38 °C)	329↑	AST 29 ALT 27 ALP 57 GGT 39 Bili 11 (tot)	Imaging CT-abdomen: unremarkable 18F-FDG PET/CT: two hepatic cysts showing signs of infection Cultures Blood: E. coli	Antibiotic i.v. piperacillin/tazobactam 4000 mg three times daily (3 days) Ciprofloxacin 500 mg twice daily (13 days)	16	3
3	54/F	5, 120	No	Fever (39.6 °C) Cold shivers No pain	245↑	AST 36 ALT 62↑ ALP 119↑ GGT 83↑ Bili 15 (indirect) Bili 8 (direct)	Imaging USG-abdomen: sludge in gallbladder Cultures Urine: negative Blood: E. coli	Antibiotic i.v. cefuroxim 750 mg three times daily (3 days) Ciprofloxacin 500 mg three times daily (11 days)	14	3
4	55/F	2, 120	Hepatic	RUQ abdominal pain Fever (38.9 °C)	N/A	AST 17 ALT 19 ALP 52 GGT 39	Imaging Chest radiograph/ USG-abdomen/ CT-abdomen: unremarkable. Repeated chest radiograph: right sided atelectasis or pneumonia 18F-FDG PET/CT: unremarkable Cultures Blood: negative	Antibiotic Ciprofloxacin 500 mg twice daily (2 days) i.v. meropenem 2000 mg and vancomycin 1000 mg (day 2) Ampicillin-tazobactam 1500 mg once daily (2 days) Amoxicillin/clavulanic acid twice daily (90 days)	90	4
5	56/F	3, 120	Hepatic	Abdominal pain Loss of appetite No fever	156↑	AST 16 ALT 15 ALP 123↑ GGT 106↑	Imaging 18F-FDG PET/CT: signs of a hepatic cyst infection Cultures Urine: negative Blood: negative	Antibiotic i.v. cefuroxim/metronidazole (day 1) Ciprofloxacin (80 days)	81	3
6	49/F	2, 90	No	Fever (38.3 °C) Cold shivers Diarrhea Abdominal cramps and pain	105↑	AST 24 ALT 21 ALP 150↑ GGT 230↑ Bili 20 (tot)↑ Bili 13↑ (direct)	Imaging Chest radiograph/ USG-abdomen: unremarkable Contrast-MRI-abdomen: both kidneys show signs of cyst bleed Cultures Urine: negative Blood: negative	Antibiotic Ciprofloxacin 500 mg twice daily (42 days)	42	5
7	57/M	19, 120	No	Fever (39.8 °C) Diarrhea Vomiting Flank pain Headache	131↑	AST 23 ALT 22 ALP 71 GGT 35 Bili 6 (indirect) Bili < 5 (direct)	Imaging Chest radiograph/ USG-abdomen: unremarkable Cultures  Urine: negative  Blood: E. coli	Antibiotic i.v. ceftriaxone 2 g bolus (day 1) i.v. ceftriaxone 2 g once daily (2 days) Ciprofloxacin 500 mg twice daily (42 days)	44	3

Reference values: all cases CRP < 5 mg/L

Case 1, 3, 6: Bili total < 17 µmol/L; Bili direct < 5 µmol/L. Women: AST < 31 U/L; ALT < 34 U/L; ALP < 98 U/L; GGT < 38 U/L. Men: AST < 35 U/L; ALT < 45 U/L; ALP < 115 U/L; GGT < 55 U/L

Case 2: Bili total < 17 µmol/L; Bili direct < 5 µmol/L; AST < 40 U/L; ALT < 45 U/L; ALP < 120 U/L; GGT < 40 for men and < 55 U/L for women

Case 4, 5, 7: Bili total < 17 µmol/L; Bili direct < 5 µmol/L. Women: AST < 30 U/L; ALT < 35 U/L; ALP < 100 U/L; GGT < 40 U/L. Men: AST < 35 U/L; ALT < 45 U/L; ALP < 115 U/L; GGT < 55 U/L

ALT alanine aminotransferase, ALP alkaline phosphatase, AST aspartate aminotransferase, Bili bilirubin, CI cyst infection, CT computed tomography, E. coli Escherichia coli, eGFR estimated glomerular filtration rate, F female, GGT gamma-glutamyl transferase, i.v. intravenous, M male, MRI magnetic resonance imaging, N/A not available, RUQ right upper quadrant, TKV total kidney volume, TLV total liver volume, tot total, USG ultrasonography, ¹⁸ F-FDG PET/CT ¹⁸fluorodeoxyglucose positron-emission computed tomography, ↑ laboratory values above reference values