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Journal of Gastrointestinal and Liver... Sep 2019
Topics: Anemia, Iron-Deficiency; Anemia, Macrocytic; Cecal Diseases; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis, Alcoholic; Malacoplakia; Male; Middle Aged; Treatment Outcome
PubMed: 31517320
DOI: 10.15403/jgld-418 -
Journal of the American Animal Hospital... 2019
Topics: Animals; Anti-Bacterial Agents; Bacterial Infections; Cystitis; Dog Diseases; Dogs; Female; Malacoplakia; Urinary Bladder Diseases; Urinary Tract Infections
PubMed: 31433228
DOI: 10.5326/JAAHA-MS-6794 -
La Revue de Medecine Interne Feb 2020
Topics: Aged; Diagnosis, Differential; Diarrhea; Eosinophilic Granuloma; Female; Humans; Inclusion Bodies; Malacoplakia
PubMed: 31421900
DOI: 10.1016/j.revmed.2019.07.001 -
Dermatology Online Journal Jun 2019Malacoplakia is a rare acquired, infection-related granulomatous disorder, that may affect many systems, but typically occurs in the urinary tract. Cutaneous involvement... (Review)
Review
BACKGROUND
Malacoplakia is a rare acquired, infection-related granulomatous disorder, that may affect many systems, but typically occurs in the urinary tract. Cutaneous involvement is less prevalent, and most commonly presents with a perianal or genital region localization. Cutaneous malacoplakia is believed to be caused by an acquired bactericidal defect of macrophages in the setting of chronic infections and immunocompromised states. A diagnosis of cutaneous malacoplakia should be considered when encountering non-specific granulomatous lesions that are refractory to treatment. Histologic findings are marked by the presence of foamy macrophages containing the pathognomonic Michaelis-Gutman bodies.
OBJECTIVES
The aim of this review is to discuss the current perspectives on the pathophysiology, clinical features, diagnosis, and treatment of this disease. We would also like to emphasize that the integration of clinical information, microscopic findings, and exclusion of other cutaneous granulomatous processes is necessary to accurately diagnose this exceedingly rare disease and provide opportunity for therapeutic intervention.
PATIENTS/METHODS
Data for this work were collected from the published literature and textbooks.
RESULTS
Combined surgical excision and protracted antibiotic courses appear to have the highest success rate. Antibiotics should be culture specific, but drugs that easily permeate the macrophages appear to be the best choice.
Topics: Anti-Bacterial Agents; Dermatologic Surgical Procedures; Granuloma; Humans; Macrophages; Malacoplakia; Phagocyte Bactericidal Dysfunction; Skin Diseases, Bacterial
PubMed: 31329385
DOI: No ID Found -
Histology and Histopathology Feb 2020Malakoplakia can be caused by incomplete digestion of Escherichia coli by lysosomes, leading to recurrent urinary tract infections and consequential mass-forming events...
CONTEXT
Malakoplakia can be caused by incomplete digestion of Escherichia coli by lysosomes, leading to recurrent urinary tract infections and consequential mass-forming events that mimic tumors.
OBJECTIVES
By using ultrastructural findings, we aimed to specify the process of phagolysosome to evoke malakoplakia.
DESIGN
We observed a series of processes to form a peculiar Michaelis-Gutmann (MG) body in three patients with malakoplakia and compared with xanthogranulomatous pyelonephritis.
RESULTS
The ultrastructural findings were realigned according to the sequence of events as pre-phagosomal, phagosomal, and post-phagosomal stages. For the mature MG body, numerous lysosomal aggregates targeting pathogens and subsequent incomplete digestion are prerequisite factors for the pre-phagosomal stage. Scattered lamellated residue is late evidence of the pre-phagosomal stage. Phagosomes can be formed by the fusion of multiple pathogens and multiple lysosomes. We utilized transmission and scanning electron microscopy to speculate on the process of phagolysosomal formation.
CONCLUSION
The recognition of E. coli captured by phagosomes or partially damaged by lysosomal attack within the cell was recorded for the first time. Furthermore, SEM observation was performed on human tissue.
Topics: Aged; Escherichia coli; Escherichia coli Infections; Female; Humans; Inclusion Bodies; Lysosomes; Malacoplakia; Male; Microscopy, Electron; Prostate; Urinary Bladder
PubMed: 31298302
DOI: 10.14670/HH-18-150 -
Annales de Pathologie Aug 2019
Topics: Actinomycetales Infections; Aged; Diagnosis, Differential; Female; Humans; Lung Diseases; Lung Neoplasms; Malacoplakia; Rhodococcus equi
PubMed: 31255413
DOI: 10.1016/j.annpat.2019.04.006 -
Journal of the College of Physicians... Jun 2019Malakoplakia is an unusual acquired granulomatous disease that can affect many systems including urogenital tract. It presents a huge diagnostic challenge as it can...
Malakoplakia is an unusual acquired granulomatous disease that can affect many systems including urogenital tract. It presents a huge diagnostic challenge as it can mimic malignancy. We report a 55-year diabetic woman who presented with history of macroscopic hematuria and right flank pain. On investigations, ultrasound of kidney, ureter and bladder (KUB) showed right hydronephroureter, and CT KUB showed right moderate hydronephroureter and right ureteric stone. Endoscopic examination revealed multiple white plaques involving urinary bladder and right ureter. The diagnosis of malakoplakia was based on microscopic findings that are specific for its diagnosis.
Topics: Anti-Bacterial Agents; Ascorbic Acid; Biopsy; Cystoscopy; Female; Hematuria; Humans; Malacoplakia; Middle Aged; Tomography, X-Ray Computed; Ultrasonography; Ureter; Urinary Bladder
PubMed: 31133162
DOI: 10.29271/jcpsp.2019.06.582 -
BMJ Case Reports Apr 2019Malakoplakia (from the Greek malakos, 'soft' and plakos 'plaque') is a granulomatous inflammatory condition, commonly presenting as a plaque in the genitourinary system,...
Malakoplakia (from the Greek malakos, 'soft' and plakos 'plaque') is a granulomatous inflammatory condition, commonly presenting as a plaque in the genitourinary system, but has been shown to affect a wide variety of structures including the skin. Presentation is varied and a high degree of clinical suspicion is needed to make a diagnosis. We report a case of cutaneous malakoplakia presenting as an inguinal swelling in a 48-year-old kidney transplant patient with temporally associated graft dysfunction. New groin swelling in an immunosuppressed patient often prompts investigation centred on a malignant cause. While this is often appropriate, less common infectious and inflammatory causes should be considered. This case highlights the importance of thorough workup and investigation, including histopathology, in immunosuppressed cohorts and acts as a reminder that less common and more complex diagnoses warrant consideration in this group.
Topics: Administration, Intravenous; Anti-Bacterial Agents; Ceftriaxone; Constriction, Pathologic; Diagnosis, Differential; Edema; Groin; Humans; Immunocompromised Host; Kidney Transplantation; Malacoplakia; Male; Middle Aged; Rare Diseases; Skin; Skin Diseases; Treatment Outcome; Ureteral Diseases
PubMed: 31015237
DOI: 10.1136/bcr-2018-227460 -
Transplantation Proceedings Apr 2019Malakoplakia is a rare granulomatous disease characterized by the presence of Michaelis-Gutmann bodies on histopathologic analysis. Lesions manifest in a wide range of...
Malakoplakia is a rare granulomatous disease characterized by the presence of Michaelis-Gutmann bodies on histopathologic analysis. Lesions manifest in a wide range of organs with cutaneous, gastrointestinal, and genitourinary systems being most common, and often result in significant comorbidities owing largely to misdiagnoses and the similar appearance to malignancy or granulomatous processes. Most patients are immunocompromised, including the solid-organ transplant population. Among organ recipients, malakoplakia is most commonly seen in renal transplantation, and only rarely reported in thoracic organ recipients. Herein we report 2 cases of malakoplakia in thoracic transplant patients that highlight the critical need for tissue diagnosis to avoid delay in management.
Topics: Aged; Female; Heart Transplantation; Humans; Immunocompromised Host; Lung Transplantation; Malacoplakia; Male; Middle Aged; Transplant Recipients
PubMed: 30979478
DOI: 10.1016/j.transproceed.2018.11.008 -
Diagnostic Pathology Mar 2019Malakoplakia is a chronic inflammatory disease characterized by tissue infiltrates of large granular macrophages containing distinctive intracytoplasmic inclusions... (Review)
Review
BACKGROUND
Malakoplakia is a chronic inflammatory disease characterized by tissue infiltrates of large granular macrophages containing distinctive intracytoplasmic inclusions termed Michaelis-Gutmann (MG) bodies. The genitourinary system is the most commonly involved site, followed by the gastrointestinal tract. Malakoplakia may occur as a complication of primary or secondary immunosuppression and, therefore, renal transplant recipients are at risk. The graft itself or extra-renal sites may be involved. Regarding the latter, six cases of colorectal malakoplakia have been reported following renal transplantation, with all but one patient experiencing significant morbidity. We describe a further example of colorectal malakoplakia following renal transplantation. The other previously reported cases are reviewed.
CASE PRESENTATION
A 72 year old female presented with left lower quadrant abdominal pain and vaginal bleeding. She had received a cadaveric renal transplant for chronic renal failure ten months previously. Abdomino-pelvic computerized tomography (CT) scanning demonstrated two lesions in the mesocolon: the first adjacent to the descending colon and the second involving the sigmoid colon. A diagnosis of sub-acute perforated diverticulitis with two phlegmons was proposed. The sigmoid lesion was resected. The descending colon lesion was treated by creation of a cutaneous fistula. Microscopy of the sigmoid lesion showed the typical features of malakoplakia. She was discharged on sulfamethoxazole-trimethoprim. Nine months later, no longer receiving antibiotic therapy, the patient reported lower left quadrant discomfort. CT scanning showed para-rectal and pelvic abdominal masses with cutaneous and intestinal fistulas. Treatment with tazobactam-piperacillin was begun and sulfamethoxazole-trimethoprim was reinstated, with subsequent slow clinical improvement. Subsequent abdominal CT scans have shown persistence of the lesions.
CONCLUSIONS
Physicians caring for renal transplant recipients should be aware of colorectal malakoplakia as a rare but serious complication. The onset may be within months or as long as a decade or more following transplantation. The clinical presentation is varied, nonspecific, and will likely suggest more common diseases. Although radiologic imaging is also nonspecific, awareness of malakoplakia is of importance to radiologists when formulating the differential diagnosis of mass lesions of the colorectum in this clinical setting. Definitive diagnosis remains dependent on pathologic examination of a biopsy or surgical resection specimen.
Topics: Aged; Anti-Bacterial Agents; Biopsy; Colon; Cutaneous Fistula; Female; Humans; Immunosuppressive Agents; Intestinal Perforation; Kidney Transplantation; Malacoplakia; Rectum; Tomography, X-Ray Computed
PubMed: 30866984
DOI: 10.1186/s13000-019-0799-z