Malakoplakia
From IDWiki
Background
- Rare inflammatory condition that occurs in immunocompromised people
- Human immunodeficiency virus, organ transplant, malignancy, diabetes mellitus, connective tissue diseases, hepatitis C, and sarcoidosis
- More common in women when it involves the urinary
- Thought to be due to defective bactericidal activity in macrophages, allowing bacteria to live intracellularly
- Escherichia coli is the most common organism that is associated
- Also Klebsiella, Proteus, Corynebacterium, Pseudomonas, Acinetobacter, Staphylococcus, Streptococcus, Enterococcus, Aerobacter, Rhodococcus, Mycobacterium, Salmonella, and Burkholderia
- Most commonly affects the genitourinary tract, but can affect essentially any organ
- More common in women when it involves the urinary tract
Clinical Manifestations
- Occurs in immunocompromised patients
- Presentation depends on the organ involved
- Appear as tender ulcerations, nodules, papules, plaques, or fungating masses
- When cutaneous, most common in perianal and genital skin
Complications and Prognosis
- Typically self-limited and may spontaneously remit over 4 to 6 months
- 81% cure with antibiotics
Differential Diagnosis
- For skin involvement: tuberculosis, lepromatous leprosy, cryptococcosis, actinomycosis, botryomycosis, leishmaniasis, condyloma lata, cutaneous Crohn disease, sarcoidosis, foreign body granuloma, hidradenitis suppurativa, granular cell tumour, xanthoma, lymphoma
Diagnosis
- Based on biopsy, where histopathology shows Michaelis-Gutmann bodies and von Hansemann cells
- Can be send for culture, too
Management
- Decrease immunosuppression, if feasible
- Surgically resect the lesions
- Treat with antibiotics that have intraceullular activity
- Ciprofloxacin 500 mg PO bid
- TMP-SMX
- Rifampin
- Antibiotics may be continued a low suppressive doses to prevent recurrence
Further Reading
- Malakoplakia of the Urogenital Tract. Urol Case Rep. 2015;3(1):6-8. doi: 10.1016/j.eucr.2014.10.002
