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Thrishulamurthy CJ, Ahmed HS, Sohail J M, Biligi DS. Clinical Evaluation and Surgical Management of Ocular Malakoplakia of the Caruncle and Periorbital Region: A Report of Two Case and Literature Review. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00369. [PMID: 38534076 DOI: 10.1097/iop.0000000000002643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Ocular malakoplakia, a rare inflammatory disorder characterized by Michaelis-Gutmann bodies, is presented in 2 unique cases involving uncommon anatomical sites-the orbit and caruncle. The first case describes a 10-year-old girl with localized subconjunctival swelling near the caruncle, prompting surgical excision, and revealing characteristic malakoplakia features. Despite medical management, surgical intervention provided symptom relief. The second case involves a painless swelling below the lower lid in a 23-year-old female, initially suggestive of lymphoma. Excision biopsy confirmed malakoplakia, emphasizing the potential for clinical misdiagnosis. Histopathological examination showcased Michaelis-Gutmann bodies, von Hansemann cells, and chronic inflammation, confirming the ocular malakoplakia diagnosis. These cases underscore the rarity of ocular malakoplakia, particularly in pediatric patients, and highlight the importance of accurate diagnosis and appropriate management.
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Affiliation(s)
| | | | | | - Dayananda S Biligi
- Department of Pathology, Bangalore Medical College and Research Institute, India
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Ajabnoor R, Mawardi M, Almutawa A. Colonic malakoplakia in a liver transplant recipient: A case report. HUMAN PATHOLOGY: CASE REPORTS 2019. [DOI: 10.1016/j.ehpc.2019.200323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Macdonald RA, Moyes C, Clancy M, Douglas P. Cutaneous malakoplakia presenting as a groin swelling and graft failure. BMJ Case Rep 2019; 12:12/4/e227460. [PMID: 31015237 DOI: 10.1136/bcr-2018-227460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
| | - Colin Moyes
- Department of Pathology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Marc Clancy
- Transplant Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Peter Douglas
- Department of Radiology, NHS Greater Glasgow and Clyde, Glasgow, UK
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Nieto-Ríos JF, Ramírez I, Zuluaga-Quintero M, Serna-Higuita LM, Gaviria-Gil F, Velez-Hoyos A. Malakoplakia after kidney transplantation: Case report and literature review. Transpl Infect Dis 2017; 19. [PMID: 28561517 DOI: 10.1111/tid.12731] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 03/05/2017] [Accepted: 03/13/2017] [Indexed: 12/11/2022]
Abstract
Malakoplakia is a granulomatous disease associated with an infectious etiology, usually involving the urinary tract. It reveals itself as a recurrent urinary tract infection (r-UTI), and in some cases, it is associated with impairment of renal function. Immunosuppression is one of its main associated factors, and it has been increasingly described in patients with solid organ transplantation (SOT), mainly kidney transplantation. Macroscopically, it can form masses and sometimes it may be confused with neoplasia, which is why histological findings are fundamental for the diagnosis. Here, we present a case of bladder malakoplakia, manifested by r-UTI from Escherichia coli in a patient with renal transplantation, refractory to long-term antibiotic treatment and reduction in immunosuppression, which resolved after surgical management. We also summarize the clinical characteristics of malakoplakia and compare them with previous reports in the literature on SOT.
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Affiliation(s)
| | - Isabel Ramírez
- Infectology, Pablo Tobón Uribe Hospital-University of Antioquia, Medellin, Colombia
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Afonso JPJM, Ando PN, Padilha MHVDQ, Michalany NS, Porro AM. Cutaneous malakoplakia: case report and review. An Bras Dermatol 2014; 88:432-7. [PMID: 23793204 PMCID: PMC3754379 DOI: 10.1590/abd1806-4841.20131790] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 06/27/2012] [Indexed: 11/22/2022] Open
Abstract
Malakoplakia is a rare acquired disease that can affect many systems but is more common in the urogenital tract. Cutaneous malakoplakia is even rarer. It is far more frequent in immunodeficient patients. We report a case of cutaneous malakoplakia in a kidney transplant patient who had recently stopped receiving immunosuppressive therapy to illustrate a review of the relevant recent literature.
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Bae GE, Yoon N, Park HY, Ha SY, Cho J, Lee Y, Kim KM, Park CK. Silent Colonic Malakoplakia in a Living-Donor Kidney Transplant Recipient Diagnosed during Annual Medical Examination. KOREAN JOURNAL OF PATHOLOGY 2013; 47:163-6. [PMID: 23667376 PMCID: PMC3647129 DOI: 10.4132/koreanjpathol.2013.47.2.163] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 07/25/2012] [Accepted: 07/26/2012] [Indexed: 01/31/2023]
Abstract
Malakoplakia is a characteristic inflammatory condition, which is usually seen in the urogenital tract, and less frequently in the gastrointestinal tract. We present a case of colonic malakoplakia in an immunocompromised patient. A 55-year-old female visited the outpatient clinic for routine cancer surveillance. Her past medical history was significant for kidney transplantation 11 years ago, and she had been taking immunosuppressants. A colonoscopy revealed several depressed flat lesions and elevated polyps, which were 0.3 to 0.4 cm in size and accompanied by whitish exudates. A biopsy revealed an infiltration of histiocytes with ample granular eosinophilic cytoplasm, with some lymphocytes and plasma cells. Many histiocytes had the characteristic morphology, described as Michaelis-Gutmann bodies: one or several round basophilic structures of approximately 1 to 10 µm in size with some being laminated, some appearing homogeneous, and others having a dense central core with a targetoid appearance. These Michaelis-Gutmann bodies were positively stained on von Kossa stain, and were diagnostic for malakoplakia.
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Affiliation(s)
- Go Eun Bae
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Colonic malakoplakia in a liver transplant recipient. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2008; 21:753-5. [PMID: 18026580 DOI: 10.1155/2007/256031] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Malakoplakia is a rare inflammatory condition seen in transplant patients. There are two previously reported cases of malakoplakia involving the gastrointestinal tract in liver transplant patients. The present paper reports a case of colonic malakoplakia in a 58-year-old woman, a liver transplant recipient who was receiving immunosuppressive drugs. She presented with chronic diarrhea while on tacrolimus. There was no history of antecedent infection. Colonoscopy showed patchy mucosal edema, but no discrete yellow plaques or nodules. The diagnosis was made by colon biopsies, which showed chronic inflammation with many histiocytes containing Michaelis-Gutmann bodies. Although rare, malakoplakia is one of many potential causes of diarrhea in a transplant patient. The present case indicates that malakoplakia may be associated with chronic diarrhea, even if there are no macroscopic lesions seen during colonoscopy.
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Teeters JC, Betts R, Ryan C, Huether J, Elias K, Hartmann D, Massey T, Chen L. Rectal and cutaneous malakoplakia in an orthotopic cardiac transplant recipient. J Heart Lung Transplant 2007; 26:411-3. [PMID: 17403486 DOI: 10.1016/j.healun.2007.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Revised: 12/22/2006] [Accepted: 01/07/2007] [Indexed: 10/23/2022] Open
Abstract
Malakoplakia, from the Greek term meaning "soft plaque," is a rare granulomatous disease first documented by Michaelis and Gutmann in 1902, and is most commonly found in association with systemic diseases such as systemic lupus erythematosus, tuberculosis, diabetes mellitus, sarcoidosis or neoplasm. We present a case report of malakoplakia in a 55-year-old female patient who had undergone an orthotopic cardiac transplant for ischemic cardiomyopathy. She was found to have an irregular rectal mass, after presenting with a complaint of hematochezia and pressure with defecation as well as a "boil" on her right labia. Malakoplakia is an exceedingly rare disease entity, and this is only the third known report of this condition in a patient after cardiac transplantation. We review the current perspectives on the pathophysiology, diagnosis and treatment of this disease.
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Affiliation(s)
- J C Teeters
- Department of Cardiology, University of Rochester Medical Center, Rochester, New York 14609, USA.
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Weinrach DM, Wang KL, Cisler JJ, Diaz LK. Pathologic Quiz Case: A 54-Year-Old Liver Transplant Recipient With Diffuse Thickening of the Sigmoid Colon. Arch Pathol Lab Med 2004; 128:e133-4. [PMID: 15387686 DOI: 10.5858/2004-128-e133-pqcayl] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- David M Weinrach
- Department of Surgical Pathology, Feinberg School of Medicine, Northwestern University, Northwestern Memorial Hospital, Chicago, Ill 60611, USA.
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Berney T, Chautems R, Berney T, Chautems R, Ciccarelli O, Squifflet JR, Latinne D, Pirson Y. Malakoplakia of the caecum in a kidney-transplant recipient: presentation as acute tumoral perforation and fatal outcome. Transpl Int 1999. [DOI: 10.1111/j.1432-2277.1999.tb01218.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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