Xanthogranulomatous cystitis with malacoplakia, leading to spontaneous intraperitoneal perforation of the urinary bladder in a 9-year-old girl

Abstract

A 9-year-old girl presented with sudden onset continuous abdomen pain, oliguria and constipation for 2 days. Ultrasound of the abdomen and voiding cystourethrography revealed intraperitoneal perforation of the urinary bladder. Cystoscopy showed two perforations at the dome of the bladder. Open surgical repair of the perforations was performed and biopsy was taken from their edges. Histopathological examination of biopsied material revealed malacoplakia with xanthogranulomatous cystitis. The patient was doing well at 15 months follow-up. Xanthogranulomatous cystitis with malacoplakia leading to spontaneous bladder perforation has not been reported earlier in the English literature.

Figure 1

(A) Ultrasound of the bladder shows the presence of a Foley's catheter balloon outside the urinary bladder. (B) Voiding cystourethrogram shows extravesical contrast into the peritoneal cavity from the urinary bladder up to the dome of the diaphragm.

Figure 2

Cystoscopy shows two perforations at the dome of the bladder (A and B).

Figure 3

Histopathological examination shows accumulation of histiocytes with granular eosinophilic cytoplasm and foamy macrophages in the lamina propria. A few histiocytes showing intracytoplasmic basophilic inclusions suggestive of xanthogranulomatous cystitis with malacoplakia (A) H&E ×5, (B) H&E ×10.