A Rare Case of Malakoplakia in a Renal Transplant Patient
- Transplantation: Clinical - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
- 2102 Transplantation: Clinical
- Serrano-Santiago, Victor E., Methodist Dallas Medical Center, Dallas, Texas, United States
- Collazo-Maldonado, Roberto L., Methodist Dallas Medical Center, Dallas, Texas, United States
- Qureshi, Muhammad Raza, Methodist Dallas Medical Center, Dallas, Texas, United States
Malakoplakia is a rare condition that affects immunocompromised patients, typically resulting in chronic inflammation, infections, and increased risk of bleeding in the affected tissues due to impaired bacterial clearance. Here we present a case of malakoplakia in a renal transplant patient that was complicated by bleeding and ultimately resulted in renal graft loss.
A 70 y/o man presented to the emergency room with abdominal pain, fullness, and an acute kidney injury. He had a medical history of end-stage renal disease due to obstructive uropathy, deceased-donor renal transplantation in 2022 with anti-thymoglobulin induction, and was currently on triple immunosuppression with tacrolimus, mycophenolate, and prednisone. Abdominal computed tomography showed a large irregular mass in the right pelvis involving the right ureter, bladder, and renal transplant. Biopsy showed malakoplakia with chronic and acute inflammation, and ultimately grew Bacillus species. A drain was placed, and the patient was discharged with four weeks of piperacillin/tazobactam. Four months later, the patient was admitted with hypotension and abdominal pain. Abdominal imaging showed a subcapsular hematoma in the native right kidney originating from the malakoplakia lesion and extending into the right ureter, which required interventional radiology embolization. Imaging showed malakoplakia was still present throughout the native urinary tract. Immunosuppression was further reduced on discharge and suppressive antibiotics were continued to allow for adequate clearance of the chronic infection. The patient was ultimately readmitted with worsening kidney disease and restarted on dialysis. Malakoplakia findings were still present and largely unchanged on imaging. Immunosuppression was completely stopped and antibiotics were continued. The patient is currently undergoing nutritional optimization and chronic suppressive antibiotic therapy with the aim of pursuing surgery to remove the native urogenital tract.
Here we show a case of malakoplakia in a renal transplant patient that required reduction of immunosuppression and subsequently led to graft function loss. Malakoplakia must be considered when imaging findings consistent with post-transplant lymphoproliferative disorder are seen in the urogenital tract.