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Cutaneous malakoplakia.

M L Nieland, A R Silverman, D Borochovitz

    The American Journal of Dermatopathology
    |January 1, 1981
    PubMed
    Summary
    This summary is machine-generated.

    This case report details cutaneous malakoplakia in an immunosuppressed patient post-renal transplant. The condition involves histiocytes with calcified Michaelis-Gutmann bodies, likely due to impaired bacterial digestion.

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    Area of Science:

    • Dermatopathology
    • Immunology
    • Nephrology

    Background:

    • Cutaneous malakoplakia is a rare inflammatory condition.
    • Immunosuppressive therapy, often following organ transplantation, can predispose patients to unusual infections and inflammatory responses.
    • Renal transplantation for end-stage nephrosclerosis requires long-term immunosuppression.

    Observation:

    • A 53-year-old female, 6 years post-renal transplant and on immunosuppressive therapy, presented with yellow-pink papular lesions.
    • Lesions were located in the natal cleft.
    • Histopathology revealed a dermal infiltrate of histiocytes (von Hansemann cells) containing calcified Michaelis-Gutmann bodies with characteristic concentric rings.

    Findings:

    • Gram-negative bacteria were identified within histiocytes.

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  • Michaelis-Gutmann bodies showed positive staining with PAS-diastase, mucicarmine, and Grocott stains, necessitating differentiation from fungal elements.
  • Electron microscopy confirmed Michaelis-Gutmann bodies originate within phagolysosomes, suggesting a defect in intracellular bacterial digestion.

    • Implications:

    • This case highlights cutaneous malakoplakia as a potential manifestation in immunosuppressed transplant recipients.
    • The findings support the hypothesis that malakoplakia results from an acquired defect in the host's ability to eliminate phagocytized bacteria.
    • Accurate histopathological differentiation from fungal infections is crucial for appropriate management.