ABSTRACT:Malacoplakia of the kidney is a rare inflammatory disorder. We describe a case of bilateral renal malacoplakia in which the patient had diffuse involvement of the left kidney and a focal lesion in the right kidney. Sonography showed a diffusely echogenic, enlarged left kidney with loss of corticomedullary differentiation and a single anechoic lesion measuring 1.8 × 1.6 × 1.3 cm in the right kidney. A left nephrectomy was performed, and the right kidney was managed conservatively with sonographic moni- Keywords: malacoplakia, renal; ultrasonography R enal parenchymal malacoplakia is an uncommon inflammatory disorder; bilateral involvement is rare. Renal parenchymal malacoplakia is usually diagnosed by histopathology, which shows the characteristic Michaelis-Gutmann (MG) bodies and von Hansemann cells. The etiology of the disorder is not known, although an immunologic defect has been proposed as a cause. Clinically, patients with renal parenchymal malacoplakia present most commonly with fever and less frequently with a mass. Nephrectomy was performed in most cases in the past 2 ; medical management has been successful in more recent cases. [2][3][4][5] Various parameters, such as the level of clinical improvement, results of urinalysis and urine culture, and serum creatinine levels, have been used to assess therapeutic responses. 3,[6][7][8] Sonography, CT, and gallium scanning have also been used for follow-up evaluations.2-5,9-14 We report a case of bilateral renal malacoplakia in which the kidney lesion on 1 side was managed conservatively and monitored using sonography.
CASE REPORTA 26-year-old woman presented with fever, chills, and left flank pain that had been present for 2 months. She also complained of anorexia and a 10-kg weight loss in the past month. The patient had no history of dysuria, diabetes, folliculitis, or abscesses, but she had been treated for pulmonary tuberculosis 20 years previously. The patient had fever (temperature, 38.3°C) with pallor and no icterus. There was a smooth, firm, mobile, tender lump in the left flank region suggestive of an enlarged left kidney. The remainder of the clinical examination was unremarkable. The results of serologic and human immunodeficiency virus tests were negative. A chest x-ray showed a fibrotic lesion in the left midzone suggestive of an old tubercular lesion. Results of laboratory studies showed: hemoglobin level, 6 g/dl; white blood cell count, 13,400 white blood cells/l with 65% polymorphs and 35% lymphocytes; erythrocyte sedimentation rate, 14 mm/hour; serum creatinine level, 1.6 mg/dl; and urine albumin level, 30 mg/dl. Microscopy showed few pus cells. Sonography, performed with an RT 3200 Advantage II ultrasound scanner (GE Medical Systems, Milwaukee, WI) and a 3.5-MHz convexarray transducer, showed a diffusely echogenic, enlarged left kidney with loss of corticomedullary differentiation ( Figure 1A) and a single anechoic lesion measuring 1.8 × 1.6 × 1.3 cm in the right kidney. Contrast-enhanced CT demonstrated a grossly enlarged, nonfunct...