[Vesico-cutaneous fistula revealing abdominal wall malakoplakia accompanied by Boeck's sarcoidosis].
Malakoplakia is an acquired granulomatous disorder first described by Michaelis and Gutmann in 1902. The pathogenesis of malakoplakia is hardly known, but it thought to be secondary to an acquired bactericidal defect in macrophages occurring mostly in immunosuppressed patients.


METHODS
63-year-old female patient had been treated with methylprednisolone for ten years, because of pulmonary sarcoidosis. For six month, recurrent abdominal abscess and vesico-cutaneous fistula developed. Histological examination proved malakoplakia, and Escherichia coli was detected in the abscess cavity.


METHODS
Hematoxyline eosin staining, periodic acid-Schiff, Berlin-blue and Kossa reactions were performed.


RESULTS
Microscopically malakoplakia consists of mainly macrophages, known as von Hansemann cells with scattered targetoid intracytoplasmic inclusions known as Michaelis-Gutmann bodies. In our presented case, after urological-surgical intervention and antibiotic therapy, the patient became free from complaints and symptoms.


CONCLUSIONS
Malakoplakia has been described in numerous anatomic locations, mainly in the urogenital tract. Malakoplakia may be complicated with fistulas in different locations: vesico-coccygeal, rectoprostatic, anorectal fistulas have been were reported in the literature, while 6 cases of malakoplakia with Boeck's sarcoidosis are published.


CONCLUSIONS
In the presented case sarcoidosis and the 10-year immunosuppressive treatment with methylprednisolone might have been in the background of abdominal wall malakoplakia, complicated by vesico-cutaneous fistula. The patient was successfully treated with surgery and the followed antibiotic therapy.
Knausz
József
J
Kanizsai Dorottya Kórház Sebészeti Osztály Nagykanizsa.
Lipták
József
J
Andrásovszky
Zsolt
Z
Baranyay
Ferenc
F
D034861:Abdominal Wall / Q000473:pathology*; D017577:Cutaneous Fistula / Q000150:complications* / Q000209:etiology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D008287:Malacoplakia / Q000139:chemically induced / Q000150:complications / Q000175:diagnosis*; D008775:Methylprednisolone / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D012507:Sarcoidosis / Q000150:complications* / Q000188:drug therapy; D001747:Urinary Bladder Fistula / Q000150:complications* / Q000209:etiology
D007166:Immunosuppressive Agents; D008775:Methylprednisolone