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European Journal of Clinical... Dec 2021Malakoplakia is a chronic granulomatous disease associated with incomplete clearance of bacterial pathogens. A multimodal approach to therapy includes antimicrobials...
Malakoplakia is a chronic granulomatous disease associated with incomplete clearance of bacterial pathogens. A multimodal approach to therapy includes antimicrobials with intracellular activity, reduction in immunosuppression, and debulking of lesions. Azithromycin has an intracellular mechanism of action and enhanced Gram-negative activity compared to other macrolides. Despite some in vitro data to support its use, there are no clinical breakpoints or epidemiological cut-off values for most Enterobacterales from the European Committee on Antimicrobial Susceptibility Testing (EUCAST) or the Clinical and Laboratory Standards Institute (CLSI). We present two cases, previously unreported, of Escherichia coli associated renal allograft malakoplakia successfully treated with azithromycin.
Topics: Allografts; Anti-Bacterial Agents; Azithromycin; Escherichia coli; Escherichia coli Infections; Female; Humans; Kidney Transplantation; Malacoplakia; Microbial Sensitivity Tests; Middle Aged; Postoperative Complications
PubMed: 33990891
DOI: 10.1007/s10096-021-04270-x -
Veterinary Pathology Jul 2021Malakoplakia in humans most often affects the urinary bladder and is characterized by inflammation with von Hansemann-type macrophages, with or without Michaelis-Gutmann...
Malakoplakia in humans most often affects the urinary bladder and is characterized by inflammation with von Hansemann-type macrophages, with or without Michaelis-Gutmann bodies, and is frequently associated with infection. We describe the microscopic features of malakoplakia in the urinary bladder of 4 puppies. In all cases, the lamina propria of the urinary bladder was markedly expanded by sheets of large, round to polygonal macrophages with intracytoplasmic, periodic acid-Schiff-positive granules and granular inclusions, and rare Prussian blue-positive inclusions. Macrophages were positive for CD18 and Iba1. In 2 cases, Michaelis-Gutmann bodies were detected with hematoxylin and eosin stain and were best demonstrated with von Kossa stain. infection was confirmed in 2 cases with bacterial culture or polymerase chain reaction (PCR) and sequencing of the bacterial 16S ribosomal RNA gene. Transmission electron microscopy of one case demonstrated macrophages with abundant lysosomes, phagolysosomes, and rod-shaped bacteria. Microscopic features were similar to human cases of malakoplakia. In dogs, the light microscopic characteristics of malakoplakia closely resemble granular cell tumors and histiocytic ulcerative colitis.
Topics: Animals; Dog Diseases; Dogs; Escherichia coli; Inclusion Bodies; Macrophages; Malacoplakia; Urinary Bladder
PubMed: 33888013
DOI: 10.1177/03009858211009779 -
Pathogens (Basel, Switzerland) Mar 2021Malacoplakia is an uncommon chronic granulomatous inflammation that rarely affects the female genital tract. A case of a 78-year-old woman with malacoplakia involving...
Malacoplakia is an uncommon chronic granulomatous inflammation that rarely affects the female genital tract. A case of a 78-year-old woman with malacoplakia involving the uterine cervix and the vagina is described. The patient complained of vaginal bleeding. Clinically, a 13-mm mass was detected in the cervix, which was confirmed by ultrasound scan and magnetic resonance imaging. Histological examination showed a dense histiocytic infiltrate with abundant Michaelis-Gutmann bodies involving the uterine cervix and the upper vagina. The presence of was confirmed in the lesion by immunohistochemistry and polymerase chain reaction. Only 12 cases of cervical malacoplakia have been reported to date. This condition should be included in the differential diagnosis of cervical tumors.
PubMed: 33804212
DOI: 10.3390/pathogens10030343 -
Journal of Cutaneous Pathology Jul 2021
Topics: Aged; Allografts; Anal Canal; Escherichia coli Infections; Humans; Immunocompromised Host; Malacoplakia; Male; Myelodysplastic Syndromes; Skin Ulcer; Stem Cell Transplantation; Transplant Recipients
PubMed: 33470456
DOI: 10.1111/cup.13761 -
Indian Journal of Urology : IJU :... 2020Malacoplakia is an inflammatory lesion which can affect any organ in the body but predominantly affects the genitourinary system and mainly the bladder. Malacoplakia of...
Malacoplakia is an inflammatory lesion which can affect any organ in the body but predominantly affects the genitourinary system and mainly the bladder. Malacoplakia of the bladder has variable presentations and is associated with urinary infection or immunosuppression. Mullerianosis of the bladder is a rare lesion that consists of two out of the three tissues, endometriosis, endocervicosis, or endosalpingiosis. It is usually associated with a previous cesarean section or pelvic surgery. The diagnosis is confirmed on histopathological examination. Malacoplakia and mullerianosis are usually isolated lesions of the bladder. We present a unique case of coexistence of malacoplakia and mullerianosis in the urinary bladder, reported for the first time in the literature.
PubMed: 33376273
DOI: 10.4103/iju.IJU_134_20 -
Clinical Nuclear Medicine Jan 2021Malakoplakia is a rare inflammatory condition that can affect many organ systems, including the genitourinary tract. It is associated with impaired immune function....
Malakoplakia is a rare inflammatory condition that can affect many organ systems, including the genitourinary tract. It is associated with impaired immune function. Isolated renal parenchymal involvement has been reported in very few cases. Urinary tract and digestive malakoplakia have been reported in transplant recipients, but the involvement of transplant itself is rare. Variable clinical manifestations and nonspecific radiological appearance make the diagnosis difficult. The differential diagnosis includes infective etiologies and malignancy. We report a case of renal allograft malakoplakia, mimicking as a malignancy on F-FDG PET/CT.
Topics: Diagnosis, Differential; Female; Humans; Kidney Neoplasms; Kidney Transplantation; Malacoplakia; Positron Emission Tomography Computed Tomography
PubMed: 33181747
DOI: 10.1097/RLU.0000000000003385 -
Transplant Infectious Disease : An... Apr 2021We describe the first published case of malakoplakia in a dual stem cell and cardiac transplant recipient. In the 2 months following cardiac transplantation, our... (Review)
Review
We describe the first published case of malakoplakia in a dual stem cell and cardiac transplant recipient. In the 2 months following cardiac transplantation, our patient developed persistent diarrhea and recurrent E coli bacteremia. Biopsies obtained from areas of colonic thickening revealed malakoplakia. Despite improvement in symptoms with prolonged antimicrobial therapy and reduction of his immunosuppression, he eventually died from sepsis. Our case highlights not only the importance of the timely diagnosis of this rare disorder, but also the difficulty in determining optimal treatment duration, particularly where excision of involved areas is not possible, as data on this disease are lacking. Here we describe our case and review the available literature published on malakoplakia in the cardiac transplant population.
Topics: Colonic Diseases; Escherichia coli; Heart Diseases; Heart Transplantation; Humans; Malacoplakia; Male; Stem Cells
PubMed: 33034139
DOI: 10.1111/tid.13488 -
Diagnostic Pathology Jul 2020Malakoplakia is an uncommon, tumor-like inflammatory disease characterized by impaired histiocytes that are unable to completely digest phagocytized bacteria. The...
BACKGROUND
Malakoplakia is an uncommon, tumor-like inflammatory disease characterized by impaired histiocytes that are unable to completely digest phagocytized bacteria. The genitourinary tract is the most common site of involvement, however, cases have also been described in the gastrointestinal tract, suggesting that it is the second most common site of involvement. This study investigates the clinical and histologic features of malakoplakia in the gastrointestinal tract.
CASE PRESENTATION
For 23 gastrointestinal specimens (biopsies and resections) from patients with a pathologic diagnosis of malakoplakia, we recorded the gender, age, location, primary diagnosis, endoscopic or surgical indication, endoscopic/gross impression and immune status (immunocompromised vs. immunocompetent).
CONCLUSION
Malakoplakia occurred throughout the length of the gastrointestinal tract with most of the cases located in the sigmoid colon and rectum (n = 10); other sites included the transverse and descending colon (n = 4), stomach/gastroesophageal junction (n = 4), appendix (n = 2), cecum (n = 1), small bowel (n = 1), and the peri-anal area (n = 1). Endoscopically, these lesions most commonly appeared as polyps (n = 10) or masses (n = 5), other clinical endoscopic impressions varied from a thickened area/fibrosis to mucosal erythema. Most patients were immunocompromised due to a disease state (e.g. organ transplantation, cancer diagnosis, autoimmune condition) and/or medication effect. Eight patients with malakoplakia were on immunosuppressive medications (8/23, 35%). Common immunosuppressed disease states included cancer (n = 9), autoimmune disease (n = 5), status post organ transplantation (n = 4), diabetes (n = 5), infection/sepsis (n = 3), and HIV/AIDS (n = 1). Some patients had multiple co-morbidities (i.e. diabetes and organ transplant). Twenty-one patients with malakoplakia were in an immunosuppressive state (21/23, 91%).
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biopsy; Child; Child, Preschool; Female; Gastrointestinal Tract; Humans; Immunocompromised Host; Immunosuppressive Agents; Malacoplakia; Male; Middle Aged; Rectum; Young Adult
PubMed: 32709245
DOI: 10.1186/s13000-020-01013-y -
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 -
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