title: Malakoplakia after renal transplantation in the current era of immunosuppressive therapy: case report and literature review.
abstract: Malakoplakia is a rare chronic granulomatous disease of unknown cause. It is thought to be caused by an acquired bactericidal defect of macrophages. Malakoplakia is associated with chronic infections and immunosuppression. Although it occurs mainly in the urinary tract, it has already been reported in almost every organ system. The isolation of bacteria, especially Escherichia coli, is common in malakoplakia patients. Here, we present a case of primary cutaneous malakoplakia in a kidney transplant recipient who had been taking prednisone, tacrolimus, and mycophenolate. Culture of a lesion grew Burkholderia cepacia complex. Treatment with high doses of trimethoprim-sulfamethoxazole was successful. We also present a systematic review of the literature, identifying 4 previously reported cases of malakoplakia after renal transplantation under similar immunosuppressive therapy, most occurring in the urinary tract or perineum and following benign courses to cure. Data in the literature suggest that malakoplakia has become even rarer since changes were made in the immunosuppressive therapy employed after kidney transplantation.
authors.affiliation: Infections in Immunocompromised Hosts Group, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: C A
authors.initials: CA
authors.lastname: Leão
authors.forename: M I S
authors.initials: MI
authors.lastname: Duarte
authors.forename: C
authors.initials: C
authors.lastname: Gamba
authors.forename: J F
authors.initials: JF
authors.lastname: Ramos
authors.forename: F
authors.initials: F
authors.lastname: Rossi
authors.forename: M M
authors.initials: MM
authors.lastname: Galvão
authors.forename: E
authors.initials: E
authors.lastname: David-Neto
authors.forename: W
authors.initials: W
authors.lastname: Nahas
authors.forename: M A
authors.initials: MA
authors.lastname: Shikanai-Yasuda
authors.forename: L C
authors.initials: LC
authors.lastname: Pierrotti
mesh_terms: D000328:Adult; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008287:Malacoplakia / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid