Minocycline infusion sclerotherapy for infected hepatic cysts in a patient with autosomal dominant polycystic kidney disease: a case report and literature review.

We report the case of a Japanese man in his 60 s undergoing hemodialysis for end-stage renal disease due to autosomal dominant polycystic kidney disease, who had experienced repeated hepatic cyst infections. Despite treatment with oral antibiotics, including minocycline and trimethoprim-sulfamethoxazole, he presented with fever and was admitted to our hospital. Diffusion-weighted magnetic resonance imaging demonstrated a high signal intensity in a large hepatic cyst, and percutaneous transhepatic drainage was performed. Enterococcus faecium was isolated from the cyst fluid. Three intracystic minocycline infusions were administered in combination with intravenous vancomycin after dialysis. The patient achieved clinical improvement and remained free from recurrence until day 253 of illness. Infections in large cysts tend to be refractory, and drainage alone may be insufficient, particularly in immunocompromised patients on hemodialysis. Intracystic sclerotherapy with minocycline offers both antimicrobial and sclerosing effects, with previous reports demonstrating cyst shrinkage and infection control in non-dialysis patients. To our knowledge, this is the first report describing successful intracystic minocycline infusion in a patient undergoing hemodialysis, and no recurrence or significant adverse events were observed. Intracystic minocycline infusion sclerotherapy may be a safe and effective therapeutic option for hepatic cyst infection in this population.