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Medicine Jun 2020Either malacoplakia or xanthogranulomatous cystitis (XC) is a rare chronic infection disease of urinary bladder, which often mimics bladder masses undifferentiated from...
RATIONALE
Either malacoplakia or xanthogranulomatous cystitis (XC) is a rare chronic infection disease of urinary bladder, which often mimics bladder masses undifferentiated from malignance and results in severe lower urinary tract symptoms. The malacoplakia combined with XC is even rarer in the literature.
PATIENT CONCERNS
A 64-year-old female, who presented with nocturia, frequency of micturition, severe urgency with occasional urinary incontinence, and recurrent hematuria for >2 years, was diagnosed with azotemia and anemia. In addition, two 1.0 × 1.0 cm masses of bladder were detected by computer tomography.
DIAGNOSES
Malacoplakia combined with xanthogranulomas cystitis was diagnosed histologically. Video urodynamic test showed poor bladder compliance (9 mL/comH2O), markedly decreased maximum bladder capacity (120 mL), and right vesicoureteral reflux at a low intravesical pressure level (25 cmH2O).
INTERVENTIONS
Transurethral resection of bladder masses was carried out after treatment of urinary infection by intravenous piperacillin-tazobactam. Oral Ciprofloxacin and Tolterodine were postoperatively used to prevent recurrent lower urinary tract infections and alleviate detrusor overactivity.
OUTCOMES
The treatment did not alleviate azotemia, frequency, urgency with incontinence, and bilateral hydroureteronephrosis, but the patient refused to undergo bladder augmentation on account of her poor economic status.
LESSONS
Malacoplakia or/and xanthogranulomas cystitis may lead to poor bladder compliance and video urodynamic study should be considered in patients with refractory chronic lower urinary tract symptoms.
Topics: Cystitis; Female; Humans; Malacoplakia; Middle Aged; Nocturia; Tomography, X-Ray Computed; Urinary Bladder; Urinary Incontinence; Urinary Tract Infections
PubMed: 32590783
DOI: 10.1097/MD.0000000000020852 -
Saudi Journal of Kidney Diseases and... Jul 2023Malakoplakia is an uncommon inflammatory disease that can involve many organ systems but is often encountered in the urogenital tract. Kidney allograft malakoplakia is...
Malakoplakia is an uncommon inflammatory disease that can involve many organ systems but is often encountered in the urogenital tract. Kidney allograft malakoplakia is even rarer and can have a diffuse parenchymal or a pseudotumoral presentation. We describe a case of grafi malakoplakia in an adult female, who presented with dull aching pain in the right loin, fever, and vomiting. Ultrasonography of the kidney graft showed a heterogeneous lesion (2.6 cm × 2.9 cm), raising suspicion of primary or metastatic renal tumors. The diagnosis was established after a histopathological examination of the kidney biopsy. This pseudotumoral presentation of malakoplakia can mimic renal cell carcinoma, lymphoma, fungal infections, or tuberculosis. It is essential to perform a biopsy for establishing the diagnosis.
Topics: Adult; Female; Humans; Kidney Transplantation; Malacoplakia; Kidney; Kidney Neoplasms; Allografts
PubMed: 38345593
DOI: 10.4103/1319-2442.395454 -
Journal of Medical Case Reports Apr 2023Malakoplakia is a rare condition characterized by inflammatory masses with specific histological characteristics. These soft tissue masses can mimic tumors and tend to...
BACKGROUND
Malakoplakia is a rare condition characterized by inflammatory masses with specific histological characteristics. These soft tissue masses can mimic tumors and tend to develop in association with chronic or recurrent infections, typically of the urinary tract. A specific defect in innate immunity has been described. In the absence of randomized controlled trials, management is based on an understanding of the biology and on case reports.
CASE PRESENTATION
Here we describe a case of presacral malakoplakia in a British Indian woman in her late 30s, presenting with complex unilateral foot drop. Four years earlier, she had suffered a protracted episode of intrapelvic sepsis following a caesarean delivery. Resection of her presacral soft tissue mass was not possible. She received empiric antibiotics, a cholinergic agonist, and ascorbic acid. She responded well to medical management both when first treated and following a recurrence of symptoms after completing an initial 8 months of therapy. Whole exome sequencing of the patient and her parents was undertaken but no clear causal variant was identified.
CONCLUSIONS
Malakoplakia is uncommon but the diagnosis should be considered where soft tissue masses develop at the site of chronic or recurrent infections. Obtaining tissue for histological examination is key to making the diagnosis. This case suggests that surgical resection is not always needed to achieve a good clinical and radiological outcome.
Topics: Female; Humans; Malacoplakia; Peroneal Neuropathies; Reinfection; Anti-Bacterial Agents; Ascorbic Acid
PubMed: 37024963
DOI: 10.1186/s13256-023-03883-4 -
Medicine Sep 2021Malakoplakia and xanthogranulomatous pyelonephritis are chronic inflammatory conditions of the kidney characterized by the infiltration of inflammatory cells.
RATIONALE
Malakoplakia and xanthogranulomatous pyelonephritis are chronic inflammatory conditions of the kidney characterized by the infiltration of inflammatory cells.
PATIENT CONCERNS
An 82-year-old female patient had a history of hypertension, type 2 diabetes mellitus, dyslipidemia, and end-stage renal disease under hemodialysis. She was admitted repeatedly 4 times within 4 months due to urosepsis.
DIAGNOSIS
The enlarged right kidney with a low-density lesion at the right middle calyx, and a well-enhanced ureter were noted on the computed tomography scan. Therefore, xanthogranulomatous inflammation was suspected. Semi-rigid ureteroscopy with biopsy was performed, and xanthogranulomatous inflammation of the ureter was confirmed on the pathology report.
INTERVENTIONS
After right open radical nephrectomy was performed, the final pathology report revealed malakoplakia with xanthogranulomatous pyelonephritis.
OUTCOMES
After the surgery, she has no longer suffered from urosepsis for 8 months, and there were no adverse event or recurrence noted.
LESSONS
With this case report, we aim to emphasize that these 2 diseases are not mutually exclusive, but they may exist simultaneously in the same patient.
Topics: Aged, 80 and over; Diagnosis, Differential; Female; Humans; Kidney Failure, Chronic; Malacoplakia; Nephrectomy; Pyelonephritis, Xanthogranulomatous; Tomography, X-Ray Computed
PubMed: 34516505
DOI: 10.1097/MD.0000000000027137 -
AIDS Research and Therapy Jan 2024Malakoplakia is a rare chronic granulomatous disease characterized by the presence of Michaelis-Gutmann bodies (MGBs) within histiocytic aggregates. It predominantly...
BACKGROUND
Malakoplakia is a rare chronic granulomatous disease characterized by the presence of Michaelis-Gutmann bodies (MGBs) within histiocytic aggregates. It predominantly affects immunocompromised individuals, including those living with Human Immunodeficiency Virus (HIV).
CASE PRESENTATION
We present a unique case of bifocal malakoplakia in a 49-year-old man, previously with Coronavirus disease 2019 (COVID-19) and HIV positive, presented with respiratory symptoms, weight loss, and lymphadenopathy. He had various infections including Non-Tuberculous Mycobacteria (NTM), Cytomegalovirus (CMV), and Candida, with evolving lung and gastrointestinal issues. Despite treatment attempts, he deteriorated due to respiratory distress, multi-organ failure, and coagulopathy, leading to his unfortunate demise.
CONCLUSION
This report presents a distinctive and complex case of malakoplakia in an HIV-positive patient, a rare inflammatory disorder originally described by Michaelis and Gutmann in 1902. The hallmark Michaelis-Gutmann organisms were observed, confirming the diagnosis. While typically affecting the urinary tract, this case demonstrates the exceptional ability of malakoplakia to manifest in various organ systems, including pulmonary, gastrointestinal, and more. Although Escherichia coli is a prevalent associated pathogen, the exact cause remains elusive. Treatment, often involving surgical excision and antibiotic therapy, underscores the challenging nature of managing this condition in immunocompromised individuals.
Topics: Male; Humans; Middle Aged; HIV; Malacoplakia; HIV Infections; HIV Seropositivity; COVID-19
PubMed: 38185638
DOI: 10.1186/s12981-024-00592-w -
The Journal of International Medical... Oct 2021Malakoplakia, a rare acquired granulomatous disease, affects many systems, including the urogenital tract. The literature describes malakoplakia of different viscera,...
Malakoplakia, a rare acquired granulomatous disease, affects many systems, including the urogenital tract. The literature describes malakoplakia of different viscera, and satisfactory results have been obtained after treatment. We reported a 48-year-old patient with diabetes who received multiple treatments in our hospital for bladder malakoplakia near the ureteral orifice. Despite aggressive treatment, the patient had recurrent bladder malakoplakia and even developed right ureteral orifice stenosis, which resulted in urinary obstruction and hydronephrosis. We believe that malakoplakia in the bladder near ureteral orifice should receive more attention. Satisfactory results may not be obtained through antibiotic treatment alone, and early antibiotic therapy combined with full surgical excision may be a better choice.
Topics: Cystitis; Humans; Hydronephrosis; Malacoplakia; Middle Aged; Ureter
PubMed: 34637357
DOI: 10.1177/03000605211050799 -
International Journal of Surgery Case... Nov 2023Malakoplakia is a rare inflammatory condition that generally occurs in immunocompromised individuals and is thought to be secondary to a bactericidal defect in...
INTRODUCTION AND IMPORTANCE
Malakoplakia is a rare inflammatory condition that generally occurs in immunocompromised individuals and is thought to be secondary to a bactericidal defect in macrophages.
CASE PRESENTATION
In this report, we present the case of a 50-year-old multiparous patient who presented with chronic pelvic pain. Ultrasonography revealed a suspicious left lateral-uterine mass. Laparoscopic exploration showed an inflammatory mass in the left adnexa adherent to the uterus, peritoneum, and meso-sigmoid. The patient underwent a total hysterectomy with bilateral salpingo-oophorectomy and peritoneal biopsy. Histological findings were consistent with a left adnexal location of malacopakia, and Bacteriological analysis revealed Escherichia coli infection sensitive to ciprofloxacin. At the 6-month follow-up, no recurrence was observed. The patient's condition improved following surgery and antibiotic treatment.
CLINICAL DISCUSSION
Genitourinary malakoplakia is more common in women and has no specific clinical, biological, or radiological features. Diagnosis is based on histological criteria, notably the presence of Michaelis-Gutmann bodies. Advances in our understanding of the pathophysiology of malakoplakia have made it possible to consider medical treatment options, mainly through the use of antibiotics. However, in cases where the organ is severely affected, surgical excision is recommended.
CONCLUSIONS
To summarize, adnexal malacoplakia is a highly uncommon disease that may be mistaken as a malignant tumor. The diagnosis is established through histological examination. The usual treatment is a combination of surgical excision followed by targeted antibiotic therapy, as the diagnosis is often not made until after surgery.
PubMed: 37939569
DOI: 10.1016/j.ijscr.2023.109012 -
Acta Medica Indonesiana Jul 2023Malakoplakia is a chronic granulomatous condition that has been rarely seen affecting the prostate. Isolated malakoplakia of the prostate occurring together with... (Review)
Review
Malakoplakia is a chronic granulomatous condition that has been rarely seen affecting the prostate. Isolated malakoplakia of the prostate occurring together with prostatic adenocarcinoma is rarer still with only 9 previously recorded cases. We present a case diagnosed through needle biopsy with prostatic adenocarcinoma and then on subsequent prostatectomy was diagnosed with extensive malakoplakia occurring with the carcinoma. Patient was noted to have a urinary tract infection (UTI) 2 weeks after needle biopsy and notably, 4 of the 9 previously reported cases also presented with UTI following their biopsies. The theory that prostatic malakoplakia may be a complication of the prostate needle biopsy is logically possible, but due to the paucity in cases, it is difficult to infer causality.
Topics: Male; Humans; Prostate; Prostatic Diseases; Malacoplakia; Prostatic Neoplasms; Adenocarcinoma
PubMed: 37915161
DOI: No ID Found -
Diagnostic Pathology Jul 2020Malacoplakia is a rare chronic inflammatory disease. The name derives from the Greek "μαλακός" meaning "soft" and "πλάξ" meaning "plaque", describing its...
BACKGROUND
Malacoplakia is a rare chronic inflammatory disease. The name derives from the Greek "μαλακός" meaning "soft" and "πλάξ" meaning "plaque", describing its usual macroscopic presentation as a friable yellow soft plaque. It was first described by von Hansemann in 1901 and by Michaelis and Gutmann in 1902. The urinary system is the most commonly involved site. Female genital tract involvement is extremely rare. Treatment is prevalently based on antibiotics with surgical intervention sometimes necessary. Prognosis is usually good, but relapse may frequently occur.
CASE PRESENTATION
This report illustrates the first case of endometrial malacoplakia in a 40 years-old patient who received endometrial curettage due to the retention of placental rests following an abortion. After conspicuous vaginal sero-hematic secretions, the patient received a further curettage. The histological examination did not show any retention of chorionic rests, but an endometrial and myometrial infiltration of histiocytes with large granular cytoplasm within a chronic inflammatory background. Immunoreactivity for CK-pool was negative, while CD68 immunostaining was strongly positive.
CONCLUSIONS
Malacoplakia of endometrium is an extremely rare condition, with few cases reported in the whole international literature. In this paper, we present the first case associated to an abortion followed by endometrial curettage procedures. This rare disease should always be attentively examined, considering, among differential diagnoses, uterine neoplasms or physiological conditions such as cumulus of foamy macrophages in the endometrium.
Topics: Abortion, Induced; Adult; Dilatation and Curettage; Endometrium; Female; Humans; Malacoplakia; Pregnancy
PubMed: 32682433
DOI: 10.1186/s13000-020-01014-x -
Clinical Nuclear Medicine Aug 2023Abdominal contrast-enhanced CT was performed in a 61-year-old man with difficulties of urination and defecation for 4 months, which revealed huge rectal masses involving...
Abdominal contrast-enhanced CT was performed in a 61-year-old man with difficulties of urination and defecation for 4 months, which revealed huge rectal masses involving multiple adjacent organs, suspected as malignant lesions. 18 F-FDG PET/CT was subsequently performed for staging. The images showed intense FDG uptake and slightly hyperdense masses involving rectum, bladder, prostate, left ureter, and the anterior abdominal wall at the level of the pelvic cavity. Histopathological examination confirmed the masses were due to malakoplakia, which displayed as abundant von Hansemann cells aggregated and infiltrated in lesions, with distinctive cytoplasmic inclusions termed Michaelis-Gutmann bodies.
Topics: Male; Humans; Middle Aged; Fluorodeoxyglucose F18; Positron Emission Tomography Computed Tomography; Malacoplakia; Positron-Emission Tomography; Neoplasms
PubMed: 37276495
DOI: 10.1097/RLU.0000000000004728