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[Cutaneous malacoplakia: a pediatric case]

O Enjolras1, J Guillemette, A Carlotti

  • 1Service de Dermatologie, Hôpital Tarnier-Cochin, Paris.

Annales De Dermatologie Et De Venereologie
|September 25, 1998
PubMed
Summary
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Cutaneous malakoplakia, a rare inflammatory condition, was diagnosed in an immunocompetent child. Prompt antibiotic therapy led to lesion resolution, highlighting effective treatment for this rare presentation.

Area of Science:

  • Dermatology
  • Pediatric Pathology
  • Infectious Diseases

Background:

  • Cutaneous malakoplakia is a rare inflammatory condition typically affecting visceral or orificial areas, seldom presenting purely on the skin.
  • It is characterized by granulomatous inflammation and the accumulation of distinctive phagocytic macrophages.

Observation:

  • A facial cutaneous lesion in an immunocompetent child, initially misdiagnosed and repeatedly excised, was confirmed as cutaneous malakoplakia after a 2-year chronic course.
  • Histopathology revealed granulomatous inflammation with phagocytic histiocytes containing Michaelis-Gutmann bodies, and cultures identified Streptococcus group B.
  • The lesion resolved following a 4-month course of oral antibiotics, including trimethoprim-sulfamethoxazole.

Findings:

  • Purely cutaneous malakoplakia is exceptionally rare, accounting for only 4% of reported cases, with most occurring in the genitourinary tract.

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  • The histopathological hallmarks include phagocytic macrophages with intracytoplasmic granules and Michaelis-Gutmann bodies.
  • Successful treatment was achieved with prolonged antibiotic therapy targeting intracellular bacteria.

    • Implications:

    • This case underscores the importance of considering cutaneous malakoplakia in pediatric dermatology, even in immunocompetent individuals.
    • Effective management relies on histopathological diagnosis and protracted antibiotic treatment with macrophage-penetrating drugs.
    • Recurrence after surgical excision is possible, emphasizing the need for appropriate medical therapy.