Malakoplakia after kidney transplantation: Case report and literature review

Abstract

Malakoplakia is a granulomatous disease associated with an infectious etiology, usually involving the urinary tract. It reveals itself as a recurrent urinary tract infection (r-UTI), and in some cases, it is associated with impairment of renal function. Immunosuppression is one of its main associated factors, and it has been increasingly described in patients with solid organ transplantation (SOT), mainly kidney transplantation. Macroscopically, it can form masses and sometimes it may be confused with neoplasia, which is why histological findings are fundamental for the diagnosis. Here, we present a case of bladder malakoplakia, manifested by r-UTI from Escherichia coli in a patient with renal transplantation, refractory to long-term antibiotic treatment and reduction in immunosuppression, which resolved after surgical management. We also summarize the clinical characteristics of malakoplakia and compare them with previous reports in the literature on SOT.

An ulcerated violaceous nodule on the thigh

“…The opposite situation, a reduction in immunosuppression, could be beneficial in patients with malakoplakia, in addition to treatment with antibiotics. 2,3 B. Intravenous sodium thiosulfate e Incorrect.…”

“… 2 The pathogenesis likely reflects impaired macrophage phagolysosome digestion of bacteria, accounting for its prevalence in immunocompromised patients, including the transplant patient population. 3 Although the presenting morphology is heterogeneous, nodules with ulceration and purulent discharge are often observed. 4 Chancroid – Incorrect.…”

“…An early histopathologic feature of malakoplakia, as seen in Fig 2 , includes von Hansemann cells, or histiocytes with lightly-staining vacuolated cytoplasm. 3 The intracytoplasmic vacuoles are periodic acid-Schiff–positive ( Fig 3 ), diastase-resistant, and are thought to result from abnormal phagocytosis of bacteria. Calcified spherical inclusions arising from these vacuoles, Michaelis-Gutmann bodies, are pathognomonic for malakoplakia.…”

“…Calcified spherical inclusions arising from these vacuoles, Michaelis-Gutmann bodies, are pathognomonic for malakoplakia. 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.…”

“…The opposite situation, a reduction in immunosuppression, could be beneficial in patients with malakoplakia, in addition to treatment with antibiotics. 2 , 3 Intravenous sodium thiosulfate – Incorrect. Intravenous sodium thiosulfate is often used to treat calciphylaxis, with a possible mechanism of action of calcium chelation and solubilization.…”