A Case of Cutaneous Malakoplakia in the Head and Neck Region and Review of the Literature

Abstract

Malakoplakia is a rare inflammatory condition that typically occurs in the urinary tract. The cutaneous form is less prevalent, and most commonly occurs in the perianal or genital regions. Here we present a 61 year old lady with cutaneous malakoplakia of the neck, which was successfully treated with surgical excision and a prolonged course of ciprofloxacin. We follow our case report with a discussion and literature review of all seventeen previously reported cutaneous head and neck malakoplakia cases from the literature. A diagnosis of cutaneous malakoplakia should be considered in nodular, ulcerated or discharging lesions that are refractory to treatment. Histology is essential, not only to diagnose malakoplakia, but also to exclude other important differential diagnoses, such as malignancy. Combined surgical excision and prolonged antibiotic courses appear to have the highest success rate. Antibiotics should be culture specific, but quinolones appear to be the best empirical choice.

A case of primary cutaneous malakoplakia in a cardiac transplant recipient

“… 2 Malakoplakia has been associated with immunosuppression such as HIV, connective tissue diseases, tuberculosis, sarcoidosis, and malignancy as well as developing in sites of surgical wounds and irradiated cancerous tissue. 2 , 3 …”

“…Immunosuppression appears to be etiologic, and one study suggests that the macrophage dysfunction can be reversed after immunosuppression is discontinued. 3 Most of the cases of cutaneous malakoplakia occurring in transplant patients have been in kidney transplant recipients. To our knowledge, only 2 other cases in heart transplant patients have been published.…”

An ulcerated violaceous nodule on the thigh

“… 3 Although the presenting morphology is heterogeneous, nodules with ulceration and purulent discharge are often observed. 4 Chancroid – Incorrect. While both chancroid and malakoplakia can present as painful ulcers, chancroid classically presents as locally destructive genital ulcers caused by the gram-negative bacterium, Haemophilus ducreyi , which did not grow from this patient's tissue culture.…”

“… 3 Although the presenting morphology is heterogeneous, nodules with ulceration and purulent discharge are often observed. 4 …”

“… 2 , 3 Von Kossa and Perls' Prussian blue stain for iron can highlight the mineralization within these bodies and assist with diagnosis. 4 Vascular calcification – Incorrect. Calcification of small-to-medium blood vessels is characteristic of calciphylaxis, not malakoplakia.…”