Acute abdominal pain and chills in an ADPKD transplant recipient

A 61-year-old female kidney transplant recipient presented with acute abdominal pain and chills. She was diagnosed with autosomal dominant polycystic kidney disease (ADPKD) at the age of 35 and had suffered from several renal cyst haemorrhages. She had been successfully transplanted with a kidney from a deceased donor 1 month earlier, after spending 5 months on haemodialysis; a right nephrectomy was performed along with the transplantation. Immunosuppressive regimen included tacrolimus, mycophenolate mofetil and steroids. The postoperative period was uncomplicated with a prompt fall of serum creatinine to 1.5 mg/dL (132 μmol/L). On clinical examination, temperature was 37.1°C, and the abdomen was slightly painful in the periumbilical area. C-reactive protein was 10.5 mg/dL, and urine analysis was normal. Computed tomography and positron emission tomography scan were performed (Figure 1).