Malakoplakia

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