Malakoplakia in a Renal Transplant: a Case Report

Overview

Malakoplakia is an uncommon inflammatory condition rarely involving parenchyma of transplan-ted kidney. We report a 44-year-old female recipient of a cadaveric renal allograft treated withcyclosporin A and prednison. After transplantation, E. coli and Citrobacter bacteruria occuredand three years later decreased graft function developed. Percutaneous needle biopsy was perfor-med and diagnosis of malakoplakia was established. Histologically, interstitial sheets of plasmo-cytes and histiocytes with periodic acid-Shiff positive cytoplasm containing Michaelis-Gutmannbodies were present. Ultrastructurally, phagolysosomes containing membrane fragments and va-rious developmental stages of inclusions to fully developed Michaelis-Gutmann bodies werefound. The patient was treated with co-piperacillin and subsequently pefloxacin and renal functi-ons improved after six months follow-up. Our case suggests that malakoplakia represents anabnormal defective histiocytic response to the infection in the setting of immunosuppressivetherapy.

Key words:
malakoplakia-kidney transplantation - diagnosis, kidney disease - pathology - needle