Renal parenchymal malakoplakia presenting as acute oliguric renal failure

A 47-year-old chronic alcoholic white male with previously normal renal function and no prior history of urinary tract infection developed the sudden onset of fever, bilateral flank pain, oliguria, and deterioration of renal function. Subsequent workup revealed massive pyuria, bilaterally enlarged kidney, and positive urine and blood cultures for E. coli. In spite of successful treatment with appropriate antibiotics and gradual improvement of the patient's clinical status, pyuria and renal failure persisted, necessitating institution of hemodialysis. 8 weeks after admission a renal biopsy revealed renal parenchymal malakoplakia.