title: Malakoplakia of the Urinary Bladder in a Patient with Chronic Lymphocytic Leukemia Under Ibrutinib Therapy: A Case Report.
abstract: Malakoplakia, a rare granulomatous disease of infectious etiology, is commonly observed in immunocompromised patients. Chronic lymphocytic leukemia (CLL) is characterized by profound immune dysregulation resulting in significant infection-related morbidity and mortality, and several drugs used in CLL treatment have a severe immunosuppressive effect. Ibrutinib, has become a new standard-of-care in patients with CLL, especially for those harboring unfavorable genetic characteristics such as 17 p deletion, with however, unknown long-term immunological consequences. Here we report a case of a patient with CLL with 17 p deletion diagnosed with malakoplakia of the urinary bladder under ibrutinib therapy who developed severe hypogammaglobulinemia during treatment administration. Presumably, ibrutinib might contribute to the development of malakoplakia on the grounds of induced immunosuppression. This case report highlights the need for regular assessment of immunogammaglobulin adequacy during treatment with ibrutinib, considering that it should be given on a permanent basis.
authors.affiliation: Department of Haematology, Athens Medical Center-Psychikon Branch, Athens, Greece ssachanas@gmail.com.
authors.forename: Sotirios
authors.initials: S
authors.lastname: Sachanas
authors.affiliation: Department of Haematology, Athens Medical Center-Psychikon Branch, Athens, Greece.
authors.forename: Gerassimos A
authors.initials: GA
authors.lastname: Pangalis
authors.affiliation: Athens Medical Center-Psychikon Branch, Athens, Greece.
authors.forename: Petros
authors.initials: P
authors.lastname: Karouzakis
authors.affiliation: Department of Haematology, Athens Medical Center-Psychikon Branch, Athens, Greece.
authors.forename: Efstathios
authors.initials: E
authors.lastname: Koulieris
authors.affiliation: Department of Haematology, Athens Medical Center-Psychikon Branch, Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Moschogiannis
authors.affiliation: Department of Haematology, Heraklion University Hospital, University of Crete, Heraklion, Greece.
authors.forename: Christina
authors.initials: C
authors.lastname: Kalpadakis
authors.affiliation: Department of Haematology, Athens Medical Center-Psychikon Branch, Athens, Greece.
authors.forename: Xanthi
authors.initials: X
authors.lastname: Yiakoumis
authors.affiliation: Department of Anatomic Pathology, Evangelismos General Hospital, Athens, Greece.
authors.forename: Dimitra
authors.initials: D
authors.lastname: Rontogianni
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives; D000361:Agammaglobulinemia / Q000139:chemically induced / Q000473:pathology*; D000368:Aged; D002872:Chromosome Deletion; D002886:Chromosomes, Human, Pair 17 / Q000235:genetics; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology; D008287:Malacoplakia / Q000139:chemically induced / Q000235:genetics / Q000473:pathology*; D010880:Piperidines; D011720:Pyrazoles / Q000008:administration & dosage / Q000009:adverse effects*; D011743:Pyrimidines / Q000008:administration & dosage / Q000009:adverse effects*; D001743:Urinary Bladder / Q000187:drug effects / Q000473:pathology*
chemical_list: D010880:Piperidines; D011720:Pyrazoles; D011743:Pyrimidines; C551803:ibrutinib; D000225:Adenine
keywords: Malakoplakia; chronic lymphocytic leukemia; hypogammaglobulinemia; ibrutinib; urinary bladder