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Updated: Jun 30, 2025
Murine Kidney Transplant Technique
Published on: October 20, 2015
Colonic malakoplakia in a pediatric renal transplant recipient case report
Kristen G Valencia Deray1, Richard Kellermayer2, Alexis C Gomez3
1Division of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
Abstract:
Malakoplakia is a rare, chronic granulomatous disease that mainly affects the genitourinary system of immunocompromised adults. It is caused by a bactericidal deficit in macrophages and, therefore, the treatment includes antimicrobials that reach high concentrations in macrophages. To our knowledge, we present the first case of malakoplakia in a pediatric solid organ transplant recipient. Our patient is a 15-year-old male renal transplant recipient who presented with recurrent diarrhea. Blood, urine, and gastrointestinal pathogen panel testing were positive for enteroaggregative Escherichia coli. A colonoscopy revealed diffuse malakoplakia. He had a complete resolution of symptoms with trimethoprim-sulfamethoxazole therapy. Unfortunately, his malakoplakia recurred after 9 months prompting the transition of therapy to oral gentamicin with subsequent remission. Malakoplakia should be considered in the differential of solid organ transplant recipients with recurrent gastrointestinal infections.
Insights
This is the first reported case of malakoplakia in a pediatric solid organ transplant recipient. The patient achieved remission with antibiotics, highlighting the importance of considering malakoplakia in transplant patients with GI infections.
Area of Science:
- Medicine
- Immunology
- Pediatrics
Background:
- Malakoplakia is a rare chronic granulomatous disease typically affecting immunocompromised adults.
- It results from a bactericidal defect in macrophages, necessitating antimicrobial treatments that achieve high intracellular concentrations.
Observation:
- A 15-year-old male renal transplant recipient presented with recurrent diarrhea.
- Enteroaggregative *Escherichia coli* was identified, and colonoscopy revealed diffuse malakoplakia.
Findings:
- Initial treatment with trimethoprim-sulfamethoxazole led to symptom resolution.
- Malakoplakia recurred after 9 months, successfully treated with oral gentamicin, achieving remission.
Implications:
- This case represents the first documented instance of malakoplakia in a pediatric solid organ transplant recipient.
- Malakoplakia should be included in the differential diagnosis for solid organ transplant recipients experiencing recurrent gastrointestinal infections.
