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Infections and Bacterial Resistance / Diverticular Disease and Complications / Infectious Disease Case Reports and Treatments · Journal article
Diseases · August 8, 2026
Early or partial results. Treat as a signal, not a conclusion.
This case series and systematic literature review consolidates experience with malakoplakia in immunocompromised hosts, describing clinical presentation, histopathology, and outcomes across 52 patients. The work is descriptive and hypothesis-generating rather than hypothesis-testing; it provides clinical characterization of a rare condition but does not measure or compare the efficacy of specific interventions.
Retrospective case series with literature review. Four institutional patients with histologically confirmed malakoplakia occurring in distinct immunocompromised states: liver transplant recipient, kidney transplant recipient, patient with relapsed acute myeloid leukemia, and patient with ulcerative colitis on immunosuppressive therapy. Literature…. Intervention: Malakoplakia management (antimicrobial therapy, observation, and/or surgical intervention). n = 4. Not stated.
Among 52 patients (4 institutional + 48 literature cases), gastrointestinal tract involvement was most common at 76.9%, followed by genitourinary tract at 19.2% Malignancy (32.7%), solid-organ transplantation (26.9%), and autoimmune disease (21.2%) were the most common underlying conditions Of 4 institutional patients: 2 achieved complete clinical and histologic resolution, 1 required transplant nephrectomy for persistent allograft infection, 1 died from progressive acute myeloid leukemia
No data on mortality rate, recurrence rate, or long-term follow-up across the 52-patient cohort
Clinicians managing immunocompromised patients should maintain suspicion for malakoplakia in the differential diagnosis of mass lesions, persistent infections, and inflammatory lesions, particularly in those with malignancy or receiving immunosuppression. Early histopathologic confirmation is essential to distinguish malakoplakia from mimicking conditions and guide management, but the heterogeneous outcomes reported suggest that treatment decisions may require multidisciplinary input and individualization.
A small retrospective case series (4 cases) combined with descriptive literature review synthesis; generates clinical insights for a rare disease but lacks control groups, prospective design, or quantified interventional outcomes to support definitive guidance.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians managing immunocompromised patients should maintain suspicion for malakoplakia in the differential diagnosis of mass lesions, persistent infections, and inflammatory lesions, particularly in those with malignancy or receiving immunosuppression. Early histopathologic confirmation is essential to distinguish malakoplakia from mimicking conditions and guide management, but the heterogeneous outcomes reported suggest that treatment decisions may require multidisciplinary input and individualization.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Background: Malakoplakia is a rare chronic granulomatous inflammatory disorder characterized by defective macrophage phagolysosomal activity and accumulation of Michaelis–Gutmann bodies on histopathology. It occurs predominantly in immunocompromised individuals and may mimic infectious, inflammatory, or neoplastic processes, creating significant diagnostic challenges. We describe four cases of malakoplakia occurring in distinct immunocompromised states and review the published literature to better characterize its clinical spectrum, management, and outcomes. Methods: We conducted a retrospective case series of four patients diagnosed with histologically confirmed malakoplakia at our institution. Cases occurred in the setting of liver transplantation, kidney transplantation, relapsed acute myeloid leukemia, and ulcerative colitis treated with immunosuppressive therapy. A literature review was performed using PubMed and Google Scholar to identify published cases of malakoplakia in immunocompromised hosts. Demographic, clinical, microbiological, therapeutic, and outcome data were extracted and analyzed descriptively. Results: Four patients with malakoplakia involving the gastrointestinal tract or renal allograft were identified. Clinical presentations ranged from incidental endoscopic findings and tumor-like colonic masses to recurrent bacteremia and graft dysfunction. Histopathologic examination demonstrated characteristic Michaelis–Gutmann bodies in all cases. Management included antimicrobial therapy, observation, and surgical intervention when necessary. Two patients achieved complete clinical and histologic resolution, one required transplant nephrectomy because of persistent allograft infection, and one died from progressive acute myeloid leukemia. Combined with 48 cases identified in the literature, 52 patients were analyzed. The gastrointestinal tract was the most frequently affected site (76.9%), followed by the genitourinary tract (19.2%). Malignancy (32.7%), solid-organ transplantation (26.9%), and autoimmune disease (21.2%) were the most common underlying conditions. Conclusions: Malakoplakia should be considered in the differential diagnosis of mass lesions, persistent infections, and inflammatory lesions in immunocompromised patients, particularly those with malignancy or receiving immunosuppressive therapy. Early histopathologic diagnosis is essential to distinguish malakoplakia from malignancy and guide appropriate management. Our findings highlight the heterogeneous clinical manifestations and outcomes of this uncommon condition and emphasize the importance of multidisciplinary evaluation in affected patients.
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