title: An adult case of cerebral malakoplakia successfully cured by treatment with antibiotics, bethanechol and ascorbic acid.
abstract: Cerebral malakoplakia is a very rare chronic inflammatory disease. We herein report the case of a 49-year-old female who presented with a slowly progressive speech disturbance and right hemiparesis. Computed tomography and magnetic resonance imaging showed irregular enhanced mass lesions with numerous scattered areas of calcification in the left insula, thalamus and basal ganglia. Histopathologically, the biopsy specimen showed basophilic laminated inclusion bodies and intracellular and extracellular calculospherules, usually with a typical targetoid appearance (Michaelis-Gutmann bodies). Treatment with antibiotics, bethanechol and ascorbic acid improved her symptoms in association with a decrease in the abnormal calcification and enhancement. The cerebral malakoplakia mimicked a brain tumor in terms of the patient's clinical course and neuroradiological image findings; however, it was successfully cured with medical treatment. This case provides evidence that the pathogenesis of cerebral malakoplakia is deeply tied to bacterial infection and that medical treatment is effective in cases of this disease.
authors.affiliation: Department of Neurosurgery, Oita University Faculty of Medicine, Oita 879-5593 Japan. Electronic address: fudaba@oita-u.ac.jp.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Fudaba
authors.affiliation: Department of Neurosurgery, Oita University Faculty of Medicine, Oita 879-5593 Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ooba
authors.affiliation: Department of Neurosurgery, Oita University Faculty of Medicine, Oita 879-5593 Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Abe
authors.affiliation: Department of Neurosurgery, Oita University Faculty of Medicine, Oita 879-5593 Japan.
authors.forename: Tohru
authors.initials: T
authors.lastname: Kamida
authors.affiliation: Department of Neurosurgery, Nagatomi Neurosurgical Hospital, Oita 870-0820 Japan.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Wakabayashi
authors.affiliation: Department of Neurosurgery, Nagatomi Neurosurgical Hospital, Oita 870-0820 Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Nagatomi
authors.affiliation: Department of Neurosurgery, Oita University Faculty of Medicine, Oita 879-5593 Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Fujiki
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001205:Ascorbic Acid / Q000627:therapeutic use*; D018723:Bethanechol / Q000627:therapeutic use*; D001921:Brain / Q000473:pathology; D002114:Calcinosis / Q000473:pathology; D005260:Female; D006801:Humans; D002479:Inclusion Bodies / Q000473:pathology; D008287:Malacoplakia / Q000188:drug therapy* / Q000473:pathology; D008875:Middle Aged; D018721:Muscarinic Agonists / Q000627:therapeutic use; D014815:Vitamins / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D018721:Muscarinic Agonists; D014815:Vitamins; D018723:Bethanechol; D001205:Ascorbic Acid
keywords: Central nervous system; Cerebral malakoplakia; Michaelis–Gutmann body