title: Hyperbaric oxygen therapy in a patient with autosomal dominant polycystic kidney disease with a perinephritic abscess.
abstract: A 68-year-old female in hemodialysis due to autosomal dominant polycystic kidney disease underwent resection of cysts in her right kidney via a laparoscopic approach due to abdominal pain. Three weeks after surgery, she was admitted with sepsis. A CT scan showed a large abscess around the right kidney. Percutaneous drainage of abscess was performed. The pus smear showed Gram-positive cocci and the culture contained methicillin-resistant Staphylococcus aureus. Ciprofloxacin, clindamycin and vancomycin were given. In the 3 weeks following admission, she remained febrile and septic and showed a progressive deterioration in her general condition, along with malnutrition and persistent drainage of purulent material from her right flank. The antibiotic therapy was changed to vancomycin, metronidazole and meropenem, but no improvement was observed. Because of the high risk associated with carrying out an open nephrectomy, we decided to use hyperbaric oxygen therapy (HBOT) as a potentially useful measure to control her infection. The patient underwent 26 daily sessions of 100% hyperbaric oxygen (2.5 atm). The use of HBOT induced a notable break in the clinical course of this patient's retroperitoneal infection. She was discharged after day 58 without any signs of inflammatory activity, and she has not presented reactivation of infection since then. We think that this case suggests that this therapy could be a new therapeutic tool in the management of patients with similar clinical features when all other therapeutic measures have failed. We did not find any other reports of the use of HBOT in infections of renal cysts.
authors.affiliation: Departamento de Medicina, Escuela de Medicina, Universidad de Valparaíso, 5 Norte 1035, Quinta Región, Viña del Mar, Chile. jvegastieb@gmail.com
authors.forename: Jorge
authors.initials: J
authors.lastname: Vega
authors.forename: Helmuth
authors.initials: H
authors.lastname: Goecke
authors.forename: Francisco
authors.initials: F
authors.lastname: Manriquez
authors.forename: Carlos
authors.initials: C
authors.lastname: Escobar
authors.forename: Max
authors.initials: M
authors.lastname: Escobar
authors.forename: Christian
authors.initials: C
authors.lastname: Videla
authors.forename: Mario
authors.initials: M
authors.lastname: Santamarina
authors.forename: Carlos
authors.initials: C
authors.lastname: Echeverria
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Guarda
mesh_terms: D000038:Abscess / Q000209:etiology* / Q000628:therapy*; D000368:Aged; D001424:Bacterial Infections / Q000628:therapy; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation; D010501:Perinephritis / Q000209:etiology* / Q000628:therapy*; D016891:Polycystic Kidney, Autosomal Dominant / Q000150:complications* / Q000628:therapy; D006435:Renal Dialysis; D016896:Treatment Outcome