Renal malakoplakia as a pseudotumoral lesion in a renal transplant patient: A case report

Abstract

Malakoplakia is a rare chronic inflammatory disease associated with gram-negative bacterial infections frequently caused by Escherichia coli. Malakoplakia usually affects the lower urinary tract (bladder) but there are cases described in the kidney as well as in the respiratory and digestive organs. We report on a case with renal parenchymal malakoplakia in a renal transplant patient and describe the pathological lesions of malakoplakia: histiocytic proliferation with scarce inflammatory infiltrate, histiocytes with acidophilic cytoplasm and the presence of characteristic Michaelis-Gutmann bodies. The authors in this study review the updated reports related to the entity in this uncommon localization, the association with an immunocompromised patient, the macroscopic presentation as a pseudotumoral lesion and the possible relationship with the xanthogranulomatous pyelonephritis as a form of a histopathological spectrum in patients affected with gram negative urinary tract infection.

Renal malacoplakia: Case report of a differential diagnosis for renal cell carcinoma

“…For patients with multifocal disease, antibiotic treatment may be favored, whereas as for patients with unifocal disease, surgical treatment is more likely to be indicated. Among antibiotics, quinolones as well as cotrimoxazole, rifampin, doxycycline, trimethoprim, and vancomycin have been shown to be effective [9,10]. In the present case of multifocal renal malacoplakia, short term treatment with ceftriaxone and ofloxacin followed by long term treatment with sulfamethoxazole/trimethoprim resulted in successful resolution.…”

Malakoplakia after kidney transplantation: Case report and literature review

“…Regarding prognosis, a cure was achieved in approximately 53% of all cases, and in 40% with involvement of the genitourinary tract. Cases have been reported of transplantation recipients with chronic graft dysfunction as a consequence of renal parenchymal disease, without recovery of the renal graft function, thus requiring nephrectomy in up to 5% of cases; or, in cases of extra‐bladder involvement, with an aggressive course that leads to a fatal outcome, with a mortality of 15% . In the case that we have reported, the malakoplakia involvement was localized to the bladder, without an extension to the graft, with initial refractoriness to immunosuppression reduction and long‐term antibiotic therapy; therefore, endoscopic surgical management was needed, which led to resolution of the disease.…”

“…13 Although data concerning the standard treatment are limited, it is essential to reduce immunosuppression, and the use of antibiotics that have intracellular action is recommended, such as quinolones, TMP-SMX, gentamicin, and choline agonists that increase cGMP levels, which have so far been shown to resolve the disease in most situations, with a good long-term prognosis. 3,14,51 However, some refractory cases need surgical resection, followed by prolonged antibiotic therapy. 51,54 The ideal treatment time remains unclear; 12-week to 6-month treatment periods have been described with variable results.…”

Cured malakoplakia of the renal allograft followed by long-term good function: A case report

“…However, renal parenchymal involvement is rare and to date less than ten cases have been reported in renal allografts [1][2][3] . The diagnosis can be confirmed only histologically and depends on microscopic detection of so-called MichaelisGutmann bodies.…”