RENAL PARENCHYMAL MALACOPLAKIA - A CASE-REPORT AND REVIEW OF THE LITERATURE

Malakoplakia is an inflammatory condition associated with persisting b acterial antigen in macrophages and characterised histologically by th e Michaelis-Gutmann body, containing bacterial fragments. We review th e pathogenesis of malakoplakia and report a novel form of treatment su ccessfully used in an 8-week-old infant with bilateral renal malakopla kia. The patient presented with an acute Escherichia coli urinary trac t infection and enlarged kidneys. Antibiotic regimes were ineffective, but once the diagnosis was made treatment was changed to an immunosup pressive regime of prednisolone and azathioprine, to which she respond ed promptly. Renal malakoplakia should be considered in any patient wi th a urinary tract infection unresponsive to antibiotics and enlarged kidneys. Although a large proportion of patients with malakoplakia hav e an underlying systemic disorder, which may account for their abnorma l macrophage function, the rest demonstrate either an isolated macroph age defect or no detectable anomaly at all. It is in this latter group we suggest that an immunomodulating regime can be curative.