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Whittington CP, Saleh JS, Schadler E, Bitar C, Wang F, Andea AA. Cutaneous malakoplakia arising on the ankle of a patient with pyoderma gangrenosum. J Cutan Pathol 2023; 50:942-946. [PMID: 37615213 DOI: 10.1111/cup.14519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/27/2023] [Accepted: 08/08/2023] [Indexed: 08/25/2023]
Abstract
Malakoplakia is a rare chronic inflammatory condition that most commonly involves the urogenital tract. Cutaneous malakoplakia is extremely rare and many patients diagnosed with skin involvement are immunosuppressed. While the clinical presentation of cutaneous malakoplakia is variable, the histopathologic features are quite distinct and include sheets of closely packed dermal histiocytes with foamy-appearing cytoplasm and Michaelis-Gutmann bodies that are positive with certain immunohistochemical stains. While the exact pathogenesis of malakoplakia is unknown, it has been associated with certain bacterial infections. Treatment generally involves a combination of surgery and antimicrobial agents and/or modulation of immunosuppressant therapy if appropriate. Herein, the authors report a unique case of cutaneous malakoplakia arising in a patient on chronic immunosuppressive therapy for the management of pyoderma gangrenosum.
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Affiliation(s)
- Carli P Whittington
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
- Departments of Pathology and Dermatology, Indiana University, Indianapolis, Indiana, USA
| | - Jasmine S Saleh
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Eric Schadler
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Carole Bitar
- Departments of Pathology and Dermatology, Tulane University, New Orleans, Louisiana, USA
| | - Frank Wang
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Aleodor A Andea
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
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Zhao Q, Dong A, Zuo C, Chen H. FDG-Avid Malakoplakia of the Ureter Mimicking Malignancy. Clin Nucl Med 2023; 48:907-909. [PMID: 37682609 DOI: 10.1097/rlu.0000000000004800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
ABSTRACT Malacoplakia is a rare chronic granulomatous disease and frequently associated with Escherichia coli infection. We describe the contrast-enhanced CT and FDG PET/CT findings in a case of bladder and ureteral malakoplakia with E. coli urinary tract infection. Contrast-enhanced CT showed multiple enhancing mural nodules in the bladder and left ureter, ranging from several millimeters to 3.1 cm. The ureteral nodules showed significantly increased FDG uptake with SUVmax of 20.4, due to histiocyte, lymphocyte, and plasma cell infiltrates revealed by histopathology.
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Affiliation(s)
- Qian Zhao
- From the Department of Nuclear Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia
| | - Aisheng Dong
- Department of Nuclear Medicine, The First Affiliated Hospital of Naval Medical University
| | - Changjing Zuo
- Department of Nuclear Medicine, The First Affiliated Hospital of Naval Medical University
| | - Haige Chen
- Department of Urology, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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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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