Abstract: PUB529
Malakoplakia in the Transplanted Kidney
Session Information
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Mwarangu, Edward, The University of Mississippi Medical Center, Jackson, Mississippi, United States
- Velagapudi, Ramya Krishna, The University of Mississippi Medical Center, Jackson, Mississippi, United States
- Simhadri, Prathap, AdventHealth, Ormond Beach, Florida, United States
- Atari, Mohammad, The University of Mississippi Medical Center, Jackson, Mississippi, United States
- Vaitla, Pradeep, The University of Mississippi Medical Center, Jackson, Mississippi, United States
Introduction
Malakoplakia is a rare chronic granulomatous disease associated with gram-negative infection especially Escherichia coli. This disease is induced by defective phagolysosomal activity of the macrophages and mainly affects the urinary bladder but has been shown to affect any solid organ, however isolated malakoplakia of the renal allograft is rare.
Case Description
Case 1 - A 66-year-old male with a deceased donor kidney transplant (DDKT), course complicated with transplant pyelonephritis. He acknowledged adherence to his medication. Six months post-transplant he developed urinary tract infection (UTI) secondary to E.Coli. A routine allograft ultrasound showed a mass which was biopsied and negative for rejection. A follow up MRI showed masses within the renal transplant and a repeat biopsy showed malakoplakia. He was started on Bactrim and a repeat MRI four months later showed unchanged malakoplakia and his antibiotics switched to cefuroxime
Case 2 - A 39-year-old female patient with a simultaneous pancreas and kidney transplant course complicated by disseminated nocardia. Developed acute pyelonephritis 1.5 years post-transplant. An allograft US showed a mass which was biopsied showing acute rejection and malakoplakia. The patient was treated for rejection and antibiotics for urinary tract infection, malakoplakia and discharged with plans to stop upon resolution. A repeat MRI six months later showed resolution of Malakoplakia.
Case 3 - A 62-year-old male with DDKT, course complicated by transplant pyelonephritis at eight weeks post-transplant. He presented few weeks later with an acute kidney injury (Creatinine 3.01, baseline 1.5-.18), CT imaging showed a nodular mass on the allograft, which was biopsied revealing malakoplakia. Malakoplakia resolved within 6 months after treatment of UTI.
Discussion
Malakoplakia can present as granulomatous renal mass and should be considered as a differential diagnosis while evaluating renal masses in transplant recipients.