[Pneumopyocystitis in a patient with adult polycystic kidney disease]. / Pioneumoquistes en paciente con enfermedad poliquística del adulto.

OBJECTIVES: We present a case of adult polycystic kidney disease, also known as autosomal dominant polycystic kidney, complicated by infection of the cysts and the formation of gas within them. METHODS/RESULTS: A 59 year old patient diagnosed of adult polycystic kidney disease with chronic renal failure on treatment with haemodialysis, who presented sepsis secondary to infection of the renal cysts. The CT scan demonstrated the presence of gas within the cysts and the microbiology revealed E. coli in one of them. Urgent nephrectomy was performed. A histological specimen of the excised organ is also presented. CONCLUSIONS: Infection of one or more cysts in adult polycystic kidney disease is a rare and serious complication which may require immediate nephrectomy, particularly if gas appears within the cysts.

[Fulminant hepatic insufficiency caused by diffuse intrasinusoidal liver metastases in a patient with transitional-cell carcinoma of the bladder]. / Insuficiencia hepática fulminante por metástasis hepática intrasinusoidal difusa en un paciente con carcinoma transicional de vejiga.

OBJECTIVE: To present a case of transitional cell carcinoma of the bladder with diffuse intrasinusoidal metastases to the liver that presented as fulminant hepatic failure. METHODS/RESULTS: A 65-year-old patient who presented at the emergency department of this hospital with fever and pain in the right hypochondrium and flank is described. Three months previously the patient had undergone operation in our department for a recurrence of a tumor affecting the bladder and urethra (Tis of the bladder and T1 GII of the prostatic urethra). The blood tests on admission were practically normal but showed alterations from the twelfth day onwards, suggesting acute liver failure in the differential diagnosis; the patient died 21 days later. The ultrasound and CT scans showed hepatomegaly with multiple heterogeneous areas which were not visible three months earlier and with no space-occupying lesions. At autopsy, the liver was found to be enlarged, with no macroscopic metastatic nodules. Microscopic examination revealed massive tumoral infiltration of the hepatic sinusoids with diffuse replacement of the hepatocytes. CONCLUSIONS: Secondary, metastatic liver cancer usually presents as multiple nodular lesions and only vary on very rare occasions as a diffuse infiltration leading to acute hepatic failure. This case provides the first description of the autopsy findings in a bladder transitional cell carcinoma with diffuse intrasinusoidal metastases to the liver.