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Case Reports
. 2024 Jun 18;25(1):200.
doi: 10.1186/s12882-024-03640-9.

A very complicated UTI: malakoplakia following E. coli urinary tract infection

Ayotola Fatola  1   2 , Benjamin C Johnson  3 , Laura Walsh  3 , Diana Fang  4 , Marissa J White  4 , Dustin Le  5 , Mohamed G Atta  5 , C John Sperati  3   5 , David N Hager  6
Affiliations
Case Reports

A very complicated UTI: malakoplakia following E. coli urinary tract infection

Ayotola Fatola et al. BMC Nephrol. .

Abstract

Malakoplakia is a rare inflammatory disorder believed to result from a defect in macrophage phagocytic function triggering a granulomatous reaction. It can present with genitourinary, gastrointestinal, or cutaneous manifestations in immunocompromised or, less commonly, immunocompetent hosts. We describe a case of renal malakoplakia in a young, otherwise healthy patient presenting with nephromegaly and sepsis following an E. coli urinary tract infection. We discuss diagnosis and management, including antibiotic selection and the decision to pursue nephrectomy. This case highlights the potential for kidney recovery with prolonged antibiotic therapy in conjunction with adjunct immunomodulatory therapies and source control.

Keywords: E. coli UTI; Malakoplakia; Michaelis-gutmann bodies.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Computed tomography scan of the abdomen/pelvis with intravenous contrast. Massive nephromegaly is present with areas of hypoperfusion and/or infarct (arrows)
Fig. 2
Fig. 2
Von Kossa stain of kidney biopsy. Brown cytoplasmic inclusions (arrowhead) within histiocytes (arrow) represent Michaelis-Gutmann bodies, characteristic of malakoplakia
Fig. 3
Fig. 3
Gross pathology of left kidney and surrounding perinephric soft tissue (overall 13.1 × 10.1 × 8.9 cm), comprised of kidney (8.6 × 6.4 × 8.5 cm) and ureter (not pictured, 5.1 cm in length x 0.4 cm in diameter). The specimen was notable for the extent of inflammation and scarring, as well as tan-yellow nodules with purulent exudate characteristic of malakoplakia
Fig. 4
Fig. 4
MRI abdomen with and without intravenous contrast performed after 1 year of antibiotic therapy. Imaging is notable for absent left kidney and improvement in right kidney morphology
See this image and copyright information in PMC

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References

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