Retroperitoneal malacoplakia: an unusual cause of ureteric obstruction

Mark, I.R.; Mansoor, Ayub; Derias, N. W.; Tiptaft, R. C.

doi:10.1111/j.1464-410x.1995.tb07768.x

Cited by 3 publications

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“…However, primary retroperitoneal malakoplakia, with no clinical evidence of genitourinary involvement, is rare [6][7][8][9]. As demonstrated by the current case, malakoplakia outside the genitourinary tract may pose significant clinical and pathologic diagnostic challenges.…”

Section: Discussionmentioning

confidence: 75%

Extragenitourinary malakoplakia in a patient with myeloma clinically mimicking extramedullary myelomatous disease

et al. 2011

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Section: Discussionmentioning

confidence: 75%

Extragenitourinary malakoplakia in a patient with myeloma clinically mimicking extramedullary myelomatous disease

et al. 2011

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“…Recently, FNAB has become a useful diagnostic tool for malacoplakia at different locations. Only one case of retroperitoneal malacoplakia diagnosed by FNAB has been previously reported [10].…”

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confidence: 97%

Therapeutic Options for Malacoplakia Secondary to Escherichia coli Infection

et al. 1999

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Malacoplakia is an uncommon chronic disease characterized by an abnormal inflammatory response to infection by gram-negative bacteria, particularly Escherichia coli. About 400 cases have been reported [1]. Usually, it affects the urinary tract. When malacoplakia affects the retroperitoneum, it is generally due to extension from an adjacent organ [2]. Diagnosis of malacoplakia is based on microscopy of a biopsy or resection specimen; however, in recent years, fineneedle aspiration biopsy (FNAB) has become a useful diagnostic technique. We report a case of primary retroperitoneal malacoplakia diagnosed by FNAB and review the clinical features of this disease.A 32-year-old male was referred to another hospital because of pain in the right flank and a low-grade fever of 5 months' duration. He had had a history of recurrent urinary tract infections. An abdominal echogram showed a retroperitoneal mass infiltrating the right iliopsoas muscle. Surgical drainage was carried out, and a large abscess was resected. Pus culture yielded E. coli.Five months later, the patient was readmitted to the same hospital with fever and a tender mass in both the right iliac fossa and the inguinal region. A fistula in the right flank was observed, and a painful subcutaneous mass extending from the right iliac fossa to the upper part of the ipsilateral thigh was found. Hemogram, results of blood chemistry analysis, CD4 ϩ and CD8 ϩ lymphocyte counts, and serum immunoglobulin levels were normal. Testing for antibody to HIV was negative. E. coli and Micrococcus were isolated from the fistula. Radiological examinations of the urinary and gastrointestinal tracts were normal. Abdominopelvic CT showed a multiloculated mass that infiltrated the right iliopsoas muscle and extended toward the inguinal region and upper part of the right thigh. FNAB of the abscess revealed multiple Michaelis-Gutmann bodies, and a diagnosis of malacoplakia was made (figure 1).Surgical resection and drainage were performed, and culture of drained pus yielded E. coli. No other abdominal lesion was found. Treatment with trimethoprim-sulfamethoxazole (TMP-SMZ) (ciprofloxacin produced gastric discomfort), bethanechol chloride, and ascorbic acid was prescribed. Clinical and radiological cures were achieved. The patient remained in good health 2 years later, still receiving and tolerating well the same treatment. We are now contemplating if this treatment should be stopped at least in part.Originally described at the beginning of this century [3, 4], malacoplakia is a rare granulomatous infectious disease that affects different organs, most frequently the urinary tract (75%) followed by the genital tract, the gastrointestinal tract, and the retroperitoneum (12%). It is characterized by an abnormal inflammatory response to infection by gram-negative bacteria, particularly E. coli. Since 1990, a new organism, Rhodococcus equi, has been related to malacoplakia in pulmonary lesions, which are generally cavitated and associated in most cases with AIDS [5].The female-to-male ratio a...

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Urinary Tract Obstruction

Frøkiær¹,

Zeidel²

2012

Brenner and Rector's the Kidney

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Retroperitoneal malacoplakia: an unusual cause of ureteric obstruction

Cited by 3 publications

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Extragenitourinary malakoplakia in a patient with myeloma clinically mimicking extramedullary myelomatous disease

Extragenitourinary malakoplakia in a patient with myeloma clinically mimicking extramedullary myelomatous disease

Therapeutic Options for Malacoplakia Secondary to Escherichia coli Infection

Urinary Tract Obstruction

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