Malakoplakia in a Transplant Kidney: A Rare Case Report

Malakoplakia is a rare inflammatory condition, commonly associated with immunosuppression. It usually affects the urinary bladder. Involvement of renal parenchyma is uncommon. This is a case report of a 49 year old renal transplant recipient with persistent graft dysfunction following an episode of urinary tract infection. Creatinine level was high and urine analysis showed pus cells and E.Coli organisms. Renal allograft biopsy was performed to rule out rejection and interstitial nephritis. The biopsy showed interstitial inflammation with histiocytes showing Michaelis-Gutmann bodies which were highlighted by Perls Prussian blue stain. Hence, the diagnosis of Malakoplakia was made. Treatment with prolonged antibiotics led to significant improvement in the creatinine value and graft function. This is a rare case which involves the renal parenchymal tissue following transplantation and correct diagnosis is required for graft survival and good prognosis.