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 Case Reports |
| A Case of Renal Parenchymal Malakoplakia Associated with E. coli Empyema |
| sang Sig Cheong, Yong Sun Ju, Jae Yong Chin, Doo Ryeon Chung, Hee Bom Moon, Kwang Hoon Kim*, Jae Hoon Song |
| Department of Internal Medicine and Urologuy*, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea |
Vol.25 Num.3 (p277~281)
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Malakoplakia is a relatively rare chronic inflammatory disease, usually involving the bladder and upper urinary tract. It represents a peculiar inflammatory response to infection by gram negative bacteria, most frequently by E. coli. Malakoplakia is characterized by the presence of large histiocytes called "von Hansemann cells" and small basophilic inclusion called "Michaelis-Gutmann bodies".
We report a case of malakoplakia involving renal parenchyme and perinephric space, also associated with E. coli empyema. The patient was a 66-year-old female with a long history of steroid treatment for rheumatoid arthritis. The patient also had a history of diabetes mellitus. The patient was admitted to the Asan medical Center because of high fever and pleuritic pain on right chest. The chest X-ray showed pleural effusion on right chest, which was characterized by low pH (6.3), markedly increased WBC count (63360/mL, poly 94%) and increased LDH level (43643 ICU) on thoracentesis. The culture of pleural fluid revealed E. coli, which was sensitive to cefazolin and gentamicin. The chest and abdominal CT scan showed huge mass shadow extending from right diaphragm to posterior aspect of right kidney as well as pleural effusion on right chest. Despite prolonged therapy with cefazolin and gentamicin, mass shadow progrssively increased in size. PCNB showed typical Michaelis-Gutmann bodies suggestive of malakoplakia. Ultmately, the patient was treated with sugical resection and prolonged course of parenteral antibiotics.
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