Abstract: SA-PO1032
Unmasking Malakoplakia: A Rare Complication in Kidney Transplantation
Session Information
- Transplantation: Clinical - 4
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Rosario Aulet, Alexandra, Methodist Dallas Medical Center, Dallas, Texas, United States
- Hazari, Akash, Methodist Dallas Medical Center, Dallas, Texas, United States
- Hanna, Wael A., Methodist Dallas Medical Center, Dallas, Texas, United States
- Qureshi, Muhammad Raza, Methodist Dallas Medical Center, Dallas, Texas, United States
Introduction
Malakoplakia is a rare granulomatous inflammatory disease associated with poor graft and patient survival. Although it frequently involves the bladder, it can also affect transplanted kidneys. Presentation varies from asymptomatic kidney dysfunction to lower urinary tract symptoms or palpable mass.
Case Description
A 38 y/o Puerto Rican male with a history of ESRD secondary to obstructive uropathy from posterior urethral valve, s/p deceased donor kidney transplant. One week post-transplant, his course was complicated with COVID-19 infection and UTI cause by multi-sensitive E. coli. Slow graft function with negative donor-specific antibodies was reported. Serum creatinine did not improve as expected when compared to mate kidney, for which decision was made to proceed with a biopsy of the transplanted kidney. Biopsy reported nuclear inclusion highlighted with Von Kossa stain, known as Michaelis Gutman bodies, supportive of a diagnosis for malakoplakia. As recommended immunosuppression regimen was adjusted, MPA dose was decreased, tacrolimus target level was lowered and started on four weeks of oral antibiotics. A follow up Scr stabilized around 2.4mg/dL, and biopsy was schedule after completion of medical therapy.
Discussion
The risk of malakoplakia increases in immunocompromised states. Treatment includes reduction of immunosuppression and targeted antimicrobial therapy. This pathology must be considered transplanted patient that presents with AKI associated with UTI. If missed can lead to significant morbidity. Kidney biopsy remains the gold standard for diagnosis.