[Chronic abdominal pain in elderly patient].

A 75-year-old female patient with autosomal-dominant polycystic kidney disease and a history of kidney transplantation presented to the emergency department with dysuria, chills and abdominal pain. A detailed review of her medical history revealed that her acute pyelonephritis was masking a chronic abdominal pain issue accompanied by significant bilirubinemia. MRCP showed a complete cystic transformation of the left liver lobe and liver fibrosis. Consequently, the diagnosis of Caroli syndrome, a rare cystic liver disease with fibrosis, was established despite her advanced age.