Colonic Malakoplakia in Renal Transplant Patient: Case Report and Literature Review
S Garzon, A Arackal, A Zaidi, S Abdalla- General Medicine
Abstract
Introduction/Objective
Malakoplakia is a relatively rare inflammatory condition defined by histiocytic infiltration with pathognomonic intracytoplasmic inclusions known as Michaelis-Gutmann bodies. The lesion has been strongly associated with immunosuppressed states. Although the exact mechanism is unknown, an infectious component, such as impaired bactericidal activity in macrophages is highly implicated which leads to deposition of calcium and iron on residual bacterial glycolipid. Although commonly identified in the genitourinary tract, malakoplakia has been found in virtually all organ systems.
Methods/Case Report
We hereby present a 44-year-old male with a history of renal transplantation, presenting with a history of chronic diarrhea for one year. Colonoscopy was performed which identified diverticulosis in the sigmoid colon and a 5 mm sessile rectal polyp. Histopathological examination of the polyp biopsy demonstrated chronic active colitis, histiocyte aggregates and numerous intracellular, basophilic, concentric, laminated and targetoid calcified structures that were highlighted by Von Kossa and iron stains. These structures are known as Michaelis-Gutmann bodies which are pathognomonic of malakoplakia. A literature review of 45 cases was completed by utilizing the PubMed database. The cases reviewed included involvement of the allograft, host kidney, bladder, colon, prostate, thyroid, submandibular gland, lung, and testicles. Many of the patients were managed with either long term antibiotics, reduction of immunosuppression, or excision of the lesion with improvement in symptoms and/or renal function.
Results (if a Case Study enter NA)
NA
Conclusion
Our case highlights the importance of diagnosing this benign entity on histology examination to allow early treatment and improvement in symptoms.