[Case of renal parenchymal malakoplakia presenting as sepsis and treated with nephrectomy]

Area of Science:

• Nephrology
• Pathology
• Inflammatory Diseases

Background:

• Malakoplakia is a rare chronic inflammatory disorder typically affecting the genitourinary tract.
• Renal parenchymal involvement in malakoplakia is exceptionally uncommon.
• Defective macrophage function is the hallmark of this condition.

Observation:

• A 46-year-old female presented with pyrexia and jaundice, initially diagnosed with left pyelonephritis, ureteral stone, and bilateral renal abscesses.
• Despite conservative management including ureteral stenting and antibiotics, the patient exhibited persistent symptoms and elevated inflammatory markers.
• Imaging revealed no significant improvement, necessitating further intervention.

Findings:

• Histopathological examination of the nephrectomy specimen revealed characteristic findings of malakoplakia, including von Hansemann cells and Michaelis-Guttmann bodies.
• The diagnosis confirmed malakoplakia as the underlying cause of the complex renal presentation.
• Surgical intervention (left nephrectomy) was curative.

Implications:

• This case underscores the importance of considering malakoplakia in the differential diagnosis of complex renal inflammatory conditions, even with atypical presentations.
• It demonstrates the efficacy of surgical management, such as nephrectomy, in refractory cases of renal malakoplakia.
• Long-term follow-up confirmed a favorable outcome and complete recovery post-nephrectomy.