Corynebacterium hofmannii infection after renal transplantation

A case of malakoplakia affecting the entire urinary tract is described. The patient had received a cadaveric renal transplant and had required particularly heavy immunosuppression because of recurrent rejection episodes. Heavy hematuria developed, and this was followed by obstruction at the vesico-ureteric junction. Despite adequate drainage via a nephrostomy, the graft ceased functioning, and was explanted. Although appropriate antibiotics were given, the patient died. The organism responsible for triggering the malakoplakia was Corynebacterium hofmannii, and this is only the third report of this organism as a human pathogen. However, other coryneform bacteria have been reported as being pathogenic in immunosuppressed subjects, and should be sought when more common organisms cannot be cultured in such patients showing signs of infection.