Abstract
Malakoplakia is an inflammatory condition associated with persisting bacterial antigen in macrophages and characterised histologically by the Michaelis-Gutmann body, containing bacterial fragments. We review the pathogenesis of malakoplakia and report a novel form of treatment successfully used in an 8-week-old infant with bilateral renal malakoplakia. The patient presented with an acuteEscherichia coli urinary tract infection and enlarged kidneys. Antibiotic regimes were ineffective, but once the diagnosis was made treatment was changed to an immunosuppressive regime of prednisolone and azathioprine, to which she responded promptly. Renal malakoplakia should be considered in any patient with a urinary tract infection unresponsive to antibiotics and enlarged kidneys. Although a large proportion of patients with malakoplakia have an underlying systemic disorder, which may account for their abnormal macrophage function, the rest demonstrate either an isolated macrophage defect or no detectable anomaly at all. It is in this latter group we suggest that an immunomodulating regime can be curative.
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References
Michaelis L, Gutmann C (1902) Über Einschlüsse in Blasentumoren. Clin Med 47: 208–215
Sanusi ID, Tio FO (1974) Gastrointestinal malakoplakia. Report of a case and review of the literature. Am J Gastroenterol 62: 356
Deridder PA, Koff SA, Gikas PW, Heidelberger KP (1977) Renal malakoplakia. J Urol 117: 428–432
Ho KL, Rassekh ZS, Nam SH (1979) Bilateral renal malakoplakia. Urology 13: 321–323
Wiggelinkhuizen J, Mills A, Emms M (1988) Bilateral renal malakoplakia in infancy. Child Nephrol Urol 9: 101–105
Charney EB, Witzleben CL, Douglas SD, Kamani N, Kalichman MA (1985) Medical management of bilateral renal malakoplakia. Arch Dis Child 60: 254–256
Sinclair-Smith C, Kahn LB, Cywes S (1975) Malakoplakia in childhood. Case report with ultrastructural observations and review of the literature. Arch Pathol 99: 198–203
Nayar RC, Garg I, Alapatt JJ (1991) Malakoplakia of the temporal bone in a nine month old infant. J Laryngol Otol 105: 568–570
Byard RW, Thorner PS, Edwards V, Greenberg M (1990) Pulmonary malakoplakia in a child. Pediatr Pathol 10: 417–424
Ho KL (1989) Morphogenesis of Michaelis-Gutmann bodies in cerebral malakoplakia. An ultrastructural study. Arch Pathol Lab Med 113: 874–879
Mohacsi G, Julesz J, Berger Z, Ormos J (1989) Bilateral renal melakoplakia in systemic lupus erythematosus and adrenogenital syndrome. Int Urol Nephrol 21: 31–38
El-Mouzan MI, Satti MB, al-Quorain AA, el-Ageb A (1988) Colonic malakoplakia — occurrence in a family. Report of cases. Dis Colon Rectum 31: 390–393
Webb M, Pincott JR, Marshall WC, Spitz L, Harvey BA, Soothill JF (1986) Hypogammaglobulinaemia and malakoplakia: response to bethanechol. Eur J Pediatr 145: 297–302
Satti MB, Abu-Melha A, Taha OM, Al-Idrissi HY (1985) Colonic malakoplakia and abdominal tuberculosis in a child. Report of a case with review of the literature. Dis Colon Rectum 28: 353–357
Witherington R, Branan WJ Jr, Wray BB, Best GK (1984) Malakoplakia associated with vesico-ureteric reflux and selective immunoglobulin A deficiency. J Urol 132: 975–977
Love RB, Bernard PA, Carpenter BF (1985) Malakoplakia of the tongue — a case report. J Otolaryngol 14: 179–182
Harfi HA, Akhtar M, Subayti YA, Ali MA, Ferentzi C, Larkworthy W (1985) Gastrointestinal malakoplakia in children. Clin Pediatr 24: 423–428
Perez-Atayde AR, Lack EE, Katz AJ, Geha RS (1983) Intestinal malakoplakia in childhood: case report and review of the literature. Pediatr Pathol 1: 337–343
Soothill JF, Harvey BA, Webb M, Marshall WC, Spitz L, Pincott JR (1983) Hypogammaglobulinaemia and malakoplakia — effect of bethanechol. Birth Defects 19: 329–330
Hamdan JA, Ahmad MS, Sa-adi AR (1982) Malakoplakia of the retroperitoneum in a girl with systemic lupus erythematosus. Pediatrics 70: 296–299
Chandra R, Kapur S (1979) Malakoplakia of the brain. A report of two cases occurring in childhood. Arch Pathol Lab Med 103: 688–692
Miranda D, Vuletin JC, Kauffmann SL (1979) Disseminated histiocytosis and intestinal malakoplakia. Occurrence due toMycobacterium intracellulare infection. Arch Pathol Lab Med 103: 302–305
Grode ML, Borit A, Van de Velde RL, Weiner L, Carton CA (1978) Cerebral malakoplakia. Bull Los Angeles Neurol Soc 43: 6–11
Trillo A, Lorentz WB, Whitley NO (1977) Malakoplakia of kidney simulating renal neoplasm. Urology 10: 472–477
Bleisch VR, Konikov NF (1952) Malakoplakia of the urinary bladder: report of four cases and discussion of aetiology. Arch Pathol 54: 388
Lem TY, Teplitz C (1974) Malakoplakia: pathogenesis and ultrastructural morphogenesis. A problem of altered macrophage (phagolysosomal) response. Hum Pathol 5: 191
Biggar WD, Keating A, Bear RA (1981) Malakoplakia: evidence for an acquired disease secondary to immunosuppression. Transplantation 31: 323–334
Stanton MJ, Maxted W (1981) Malakoplakia: a study of the literature and current concepts of pathogenesis, diagnosis and treatment. J Urol 125: 139–146
Thorning D, Vracko R (1975) Malakoplakia. Defect in digestion of phagocytosed material due to impaired vacuolar acidification? Arch Pathol 99: 456
Abdou NI, Napombejara C, Sagawa A, et al. (1977) Malakoplakia: evidence for monocyte lysosome abnormality correctable by cholinergic agonist in vitro and in vivo. N Engl J Med 297: 1413–1419
Biggar WD, Crawford L, Cardella C, Bear RA, Gladman D, Reynolds WJ (1985) Malakoplakia and immunosuppressive therapy. Reversal of clinical and leucocyte abnormalities after withdrawal of prednisone and azathioprine. Am J Pathol 119: 5–11
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Saleem, M.A., Milford, D.V., Raafat, F. et al. Renal parenchymal malakoplakia —a case report and review of the literature. Pediatr Nephrol 7, 256–258 (1993). https://doi.org/10.1007/BF00853212
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DOI: https://doi.org/10.1007/BF00853212