CUTANEOUS MALACOPLAKIA - A REPORT OF 2 CASES AND REVIEW OF THE LITERATURE

Malacoplakia, an inflammatory disease characterized by accumulations o f phagocytic macrophages, occurs primarily in immunocompromised indivi duals. Cutaneous involvement is rare. Two men, each with a renal allog raft, had expanding nodules on the temple and perianal area (case 1) a nd perianal, inguinal, and scrotal skin (case 2). Lesions resolved aft er combined surgical and antibiotic therapy. Histopathologic examinati on showed dense infiltration with large phagocytic macrophages contain ing round, concentric, laminar Von Kossa stain-positive inclusion bodi es. Histiocytes had positive results for CD 68, lysozyme, and alpha(1) -antitrypsin. Electron microscopic examination demonstrated rare intra cytoplasmic inclusion bodies with concentric electron-dense lamination s of calcium (Michaelis-Gutmann bodies.) Cutaneous malacoplakia should be considered in the differential diagnosis of nodules or draining ul cers, particularly in immunocompromised patients. Because Michaelis-Gu tmann bodies are difficult to identify, specimens should be evaluated for cutaneous malacoplakia by immunohistochemical or electron microsco pic means.