Malakoplakia: a possible complication of poorly controlled diabetes mellitus?

History and admission findings: A 47-year-old woman with poorly controlled diabetes mellitus (HbA(1c) 9.2%, fasting blood glucose > 200 mg/dl) had com plaianed of moderately severe stabbing pain in the left abdomen. On admissi on there were no abnormal findings on abdominal palpation. Investigations: Abdominal ultrasound and computed tomography (CT) revealed a partly solid partly cystic well-circumscribed space-occupying lesion, abo ut 15 cm in diameter, in the left abdomen, extending from the lower third o f the kidney into the pelvis. Diagnosis, treatment and course: Biopsy of the lesion showed chronic granul ating inflammation with foamy histiocytes (Hansemann macrophages) as charac teristic substrate of extensive malakoplakia. Despite the size of the lesio n it was not excised but long-term treatment with ciprofloxacin undertaken. At the same time, the diabetes was carefully controlled with ordinary insu lin. Ten months later there was no longer any evidence of the lesion by ult rasound and CT. Conclusions: Even extensive malakoplakia can be successfully treated with c iprofloxacin. Poorly controlled diabetes together with a weak immune status (CD4/CD8 less than or equal to 1) may have favoured the occurrence of mala koplakia.