Renal Failure Caused by Malakoplakia lesions of the Urinary Bladder

Stamatiou, Konstantinos; Chelioti, Eleni; Tsavari, Aikaterini; Koulia, Kalliroi; Papalexandrou, Alexia; Efthymiou, Evdokia; Tsilivigkou, Maria; Vasilakaki, Thivi

doi:10.5812/numonthly.18522

Cited by 17 publications

(17 citation statements)

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“…Malakoplakia is a rare chronic inflammatory condition typically affecting the urinary tract and retroperitoneal tissue [ 1 ]. It is characterized histologically by granulomatous inflammation and by the presence of von Hansemann histiocytes containing intra-cytoplasmic inclusions named Michaelis-Gutmann bodies [ 1 ]. Despite more than a century since first being described, the pathophysiology of the disease remains poorly understood.…”

Section: Case Reportmentioning

confidence: 99%

“…Despite more than a century since first being described, the pathophysiology of the disease remains poorly understood. It is thought to occur secondary to immune system dysregulation and defects in phagocyte function manifesting as granulomatous inflammation [ 1 ]. It is associated with immunosuppression, seen more commonly in patients with lymphoma and diabetes mellitus [ 2 ].…”

Section: Case Reportmentioning

confidence: 99%

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Malakoplakia, a malignant mimic

Parkin¹,

Acland²,

Sulaiman³

et al. 2020

Bladder

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Malakoplakia is a chronic inflammatory condition that affects multiple systems, most commonly the urogenital tract. Its clinical presentation is often non-specific, but is typically characterized by recurrent urinary tract infections and haematuria. We report a rare case of intravesical malakoplakia mimicking an aggressive transitional cell carcinoma both in its clinical presentation and in its macroscopic appearance on cystoscopy in an 82-year patient, the oldest reported case in the literature. Malakoplakia has been described in the literature as a benign disease process presenting typically in younger patients. This case demonstrates its ability to cause obstructive uropathy and affect elderly patients. Thus, this case serves as a reminder to consider malakoplakia as a differential in the evaluation of suspected bladder malignancy in patients of all ages.

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Section: Case Reportmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

Malakoplakia, a malignant mimic

Parkin¹,

Acland²,

Sulaiman³

et al. 2020

Bladder

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“…Bladder malacoplakia can occur in both men and women, but it occurs more commonly in the latter, with a male-to-female ratio of about 1:4. Most patients were over 40 years of age, but occasionally children or adolescents were among the reported cases[ 4 ]. The incidence of bladder malacoplakia accounts for approximately 40% of malacoplakia cases.…”

Section: Discussionmentioning

confidence: 99%

Bladder malacoplakia: A case report

Wang¹,

Hang²,

Wang³

et al. 2022

WJCC

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BACKGROUND Bladder malacoplakia is a rare chronic granulomatous disease. The most common site of the malacoplakia is the urinary system. The etiology of bladder malacoplakia is complex, with its clinical misdiagnosis rate is high. Therefore, exposure to more clinical cases is necessary to improve the diagnosis and treatment of this condition. CASE SUMMARY A 65-year-old woman was admitted to our hospital because of dysuria. She presented with dysuria, frequent urination, urgency, pain, and absence of hematuria and pyuria. After the examination, bladder tumor electrocision was performed under combined intravenous and inhalation anesthesia on September 6, 2021. During the operation, electrotomy and electrocoagulation were performed. The operation was then followed by anti-infection treatment, and the patient recovered well. The postoperative pathology was diagnosed as bladder malacoplakia by light and electron microscopic analyses. On a follow-up after 4 mo, no significant difference between electrotomy and electrocoagulation was found, with both achieving a curative effect. CONCLUSION Diagnosing bladder malacoplakia depends on histopathological examination. Antibiotic treatment with bladder tumor resection or electrocoagulation provides better therapeutic effect.

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“…Antibiotic against E. coli is an effective treatment of malakoplakia [12]. The prolonged course of antibiotics or combined use of quinolone antibiotics together with trimethoprim-sulfamethoxazole has been shown to improve the outcome of malakoplakia [5,7,12,13]. As the etiology of malakoplakia was related to immunosuppression, several studies report that the disease regressed when the patient was rendered into a less immunosuppressed state [7,9,12].…”

Section: Discussionmentioning

confidence: 99%

“…The disease is female predominance (female-male ratio of 4:1), but there is no particular racial predilection [5,6]. Malakoplakia tends to occur in an older age group (average: 50 years old), with a range from 6 weeks to 85 years old [6].…”

Section: Discussionmentioning

confidence: 99%

Malakoplakia of the Urinary Tract: A Benign Disease with a Possible Malignant Outcome

Wong¹,

Yeung²,

Lee³

et al. 2016

JCR

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Abstract:Introduction: Malakoplakia is a rare chronic inflammatory disease which commonly affects the urogenital tract. The exact pathogenesis is not fully understood, but some associated conditions which include immunodeficiency, malignancy or chronic bacterial infection, have been suggested. The definite diagnosis relies on identifying the Michaelis-Gutmann bodies microscopically. Case Report: A 62-year-old woman with poorly controlled diabetes mellitus presented with gross hematuria for a few months. Subsequent investigations showed a positive urine culture (Escherichia coli -E. coli), and flexible cystoscopy showed a 1 cm plaque-like lesion at the left posterior wall of the urinary bladder as well as several smaller, similar lesions noted at various different sites. Biopsy of the lesion showed a proliferation of macrophages (CD68+) with abundant, glandular cytoplasm and the presence of Michaelis-Gutmann bodies (PAS+, Von Kossa+), which was consistent with malakoplakia. Computed Tomography (CT) urogram showed no hydronephrosis, with good contrast excretion from both kidneys as well as satisfactory drainage down to the bladder. She was then treated with antibiotics, but still had on and off urinary tract infection. About a year later, she presented with urosepsis and acute renal failure, and was admitted to the urological ward. Urgent CT urogram showed bilateral hydronephrosis with both lower ureters distended with hyperdense contents (malakoplakia plaques). Emergency bilateral percutaneous nephrostomy (PCN) was performed. Her condition was stabilized with antibiotics, and her renal function improved with PCN drainage. Several treatment options were offered to the patient, but in view of her significant pre-morbid condition, she opted for bilateral long-term PCN. Conclusion: Malakoplakia was thought to be a treatable and relatively benign disease, but in some cases, it might result in renal failure due to bilateral ureteric involvement. Early diagnosis together with adequate antibiotic treatment is important in patients with malakoplakia, and they should be closely followed up to prevent future development of renal insufficiency.

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Renal Failure Caused by Malakoplakia lesions of the Urinary Bladder

Cited by 17 publications

References 2 publications

Malakoplakia, a malignant mimic

Malakoplakia, a malignant mimic

Bladder malacoplakia: A case report

Malakoplakia of the Urinary Tract: A Benign Disease with a Possible Malignant Outcome

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