Silent Colonic Malakoplakia in a Living-Donor Kidney Transplant Recipient Diagnosed during Annual Medical Examination

Abstract

Malakoplakia is a characteristic inflammatory condition, which is usually seen in the urogenital tract, and less frequently in the gastrointestinal tract. We present a case of colonic malakoplakia in an immunocompromised patient. A 55-year-old female visited the outpatient clinic for routine cancer surveillance. Her past medical history was significant for kidney transplantation 11 years ago, and she had been taking immunosuppressants. A colonoscopy revealed several depressed flat lesions and elevated polyps, which were 0.3 to 0.4 cm in size and accompanied by whitish exudates. A biopsy revealed an infiltration of histiocytes with ample granular eosinophilic cytoplasm, with some lymphocytes and plasma cells. Many histiocytes had the characteristic morphology, described as Michaelis-Gutmann bodies: one or several round basophilic structures of approximately 1 to 10 µm in size with some being laminated, some appearing homogeneous, and others having a dense central core with a targetoid appearance. These Michaelis-Gutmann bodies were positively stained on von Kossa stain, and were diagnostic for malakoplakia.

Malakoplakia of the colon following renal transplantation in a 73 year old woman: report of a case presenting as intestinal perforation

“…Shah (2010) [11]45/M3 yearsType 1 DM/Live-unrelatedCecum, right colon, sigmoidWatery diarrheaAntibiotics, reduced immuno-suppression/Alive.6. Bae (2013) [6]55/F11 yearsIgA nephropathy/Live, relationship not specifiedAscending colon, transverse colonAsymptom-aticNone/Alive.7. Present Case (2018)72/F10 monthsFSG/CadavericDescending colon, sigmoidAcute abdomen due to perforationAntibiotics, sigmoidectomy/Alive. CRF chronic renal failure, ADPKD Autosomal dominant polycystic kidney disease, DM Diabetes mellitus, FSG focal segmental glomerulosclerosis…”

Megalocytic Interstitial Nephritis Following Acute Pyelonephritis with Escherichia coli Bacteremia: A Case Report

“…Although inflammation is caused by infiltration by various inflammatory cells, histiocytes (a type of immune cell that eliminates foreign materials as a part of the host defense) were reported to play a key role in the pathogenesis of megalocytic interstitial nephritis ( 6 ). The pathogenic mechanism is suspected to be associated with impairment of bacterial clearance by neutrophils and macrophages, especially in immunodeficient patients ( 7 ). Alcohol abuse, as in our patient, was reported as another risk factor of this disease.…”

Malakoplakia after kidney transplantation: Case report and literature review

“…Based on our literature review, it was more prevalent in women (61.1% of cases), and it has been described from the early days of transplantation and up to 15 years later (median 24 months p25‐75: 12.75‐69 months) (Table ). We found that malakoplakia was reported more often in kidney transplantation, and the most common form is involvement of isolated renal parenchyma, where it usually presents as r‐UTI and graft dysfunction in up to 74% of cases, as a pseudotumoral mass in up to 33% of cases, followed, in order of frequency, by compromise of kidney and bladder, GI tract, colon, cecum, rectum, and the perianal region. In the latter cases, fistulas are present, as well as pseudotumoral lesion; and at least one case was associated with chronic diarrhea, plus an asymptomatic case .…”

“…We found that malakoplakia was reported more often in kidney transplantation, and the most common form is involvement of isolated renal parenchyma, where it usually presents as r-UTI and graft dysfunction in up to 74% of cases, 2,4-15 as a pseudotumoral mass in up to 33% of cases, 9,10,[13][14][15][16] followed, in order of frequency, by compromise of kidney and bladder, 17-20 GI tract, colon, 21-23 cecum, 24 rectum, 21 and the perianal region. In the latter cases, fistulas are present, as well as pseudotumoral lesion 21,24,25 ; and at least one case was associated with chronic diarrhea, 22 plus an asymptomatic case. 22 Cases with involvement of skin [26][27][28] and perineum have also been reported, 3 and compromise of the submandibular gland 29 ; another case with perianal and pulmonary involvement was reported, 30 and even a case with abdominal wall abscess.…”

“…In the latter cases, fistulas are present, as well as pseudotumoral lesion 21,24,25 ; and at least one case was associated with chronic diarrhea, 22 plus an asymptomatic case. 22 Cases with involvement of skin [26][27][28] and perineum have also been reported, 3 and compromise of the submandibular gland 29 ; another case with perianal and pulmonary involvement was reported, 30 and even a case with abdominal wall abscess. 31 Most infrequent forms occurred in the native urinary tract 32 and ureter, manifested as hydronephrosis, 32 prostate, [33][34][35] isolated bladder, 36,37 and just one case reported of testicular involvement 38 (Table 1).…”