Pulmonary malakoplakia associated with immunodeficiency by HTLV-1 and HIV

Abstract

Malakoplakia is a rare chronic inflammatory disease often confused with neoplasia. In this paper we report two cases of pulmonary Malakoplakia, both with typical clinical diagnosis of tuberculosis and lung cancer. A patient with human T-lymphotropic virus type I (HTLV-1) and diagnosis of adult T-cell leukemia/lymphoma, and another patient with human immunodeficiency virus (HIV), which was treated for tuberculosis, but, after pulmonary lobectomy, was evidenced Rodococosis equi, progressed to death.

Malakoplakia in a colonic tubular adenoma: a unique case presentation

“…The word malacoplakia was suggested by Professor von Hansemann himself, and it was derived from Greek words malakos (soft) and plakos (plaque) [3]. The mode of the occurrence in relation to age is characterised by bimodal pattern, the first prevalence is below age of 13 and the second group is the middle -aged adults, however the average age at diagnosis is 50 years [12][13][14][15][16][17][18]. It has since been reported at other sites, including the gastrointestinal tract (GIT) [7,8,19], the skin [9], the vagina [10], the central nervous system [20], the lungs [21], pancreas [15] and the gallbladder [22].The second group is the middle-aged adults, however the average age at diagnosis is 50 years [12][13][14].…”

“…Malakoplakia was first reported outside of the genitourinary system in 1958 by Haukohl and Chinchinian [23]. Regarding the GIT involvement, it has been regarded as the second most common site (12-15%) [14], and frequently seen in the left hemi-colon, between the descending colon and rectum [19,24].The pathogenesis of malakoplakia is not completely understood, but three possible mechanisms have been suggested [16]. These mechanisms suggest that malakoplakia may be due to specific microorganisms, from which Escherichia coli, Mycobacterium tuberculosis, Proteus, and Staphylococcus aureus are the most likely agents, an abnormal or altered immune response in the patient, or due to defective lysosomal function In immunocompromised patients, chronic infection may result in lowering levels of cyclic guanosine monophosphate nucleotide (cGMP) in the cellular microtubules.…”

“…This nucleotide acts as a second messenger much like cyclic AMP (adenosine monopho-sphate), and it plays part in activation of intracellular protein kinases. The protein kinases are the enzymes which are helpful in phosphorylation of many proteins, among, them the immunoglobulins and lytic enzymes [14,15]. The macrophages are still able to engulf the bacteria, however unable to destroy them.…”

“…The outcome will be the presence of intracellular inclusion bodies, formed of undigested bacterial bodies, glycolipid, iron and calcium deposits, giving the appearance of Michaelis-Gutmann bodies (MGBs).These inclusion bodies usually stain positive with Von-Kossa and Prussian Blue stains. The association of the malakoplakia and the immunological conditions as immunodeficiency or immunosuppression as in transplantation has been reported [14,15]. Malakoplakia found within the genitourinary tract is most often associated with an Escherichia coli infection.…”