Volume 5, Number 51; June 14, 2006
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Volume 5, Number 51; June 14, 2006 |
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48-year-old African-American female with dysuria.
Recommended reading:
Malacoplakia: a 25-year experience with a review of the literature.
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Patient: 48 year old African-American female presented with diffuse abdominal pain and dysuria. There was a history of heavy alcohol use. Upon examination patient exhibited frosty, flaky skin and there were decreased breath sounds and a trace of lower extremity edema. Labs revealed severe acidosis and renal failure (bun > 200, cr = 16.3), anemia, and high white count. Chest Xray revealed lung infiltrate/effusion and CT revealed a cavitary lesion. Bronch was negative. Further diagnostic workup pointed to an obstructive process in the ureter.
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Session Handout: Link Directly to Fulltext Article at Science Direct <1> Unique Identifier [PMID]: 15711361 Authors: Blair JE. Maclennan GT. Institution: Institute of Pathology, University Hospitals of Cleveland,; Case Western Reserve University, Cleveland, Ohio, USA. Title: Malakoplakia.
Source: Journal of Urology. 173(3):986, 2005 Mar. Publication Type: Journal Article.
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Clinical Question: 1) What is malacoplakia of the bladder and how is it diagnosed and treated?
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Readings:
Link Directly to Fulltext article in Ovid <2> Unique Identifier [PMID]: 8604965 Authors: van der Voort HJ. ten Velden JA. Wassenaar RP. Silberbusch J. Institution: Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. Title: Malacoplakia. Two case reports and a comparison of treatment modalities based on a literature review. [Review] [118 refs]
Source: Archives of Internal Medicine. 156(5):577-83, 1996 Mar 11. Abstract: Malacoplakia is a rare infectious disease that has been almost exclusi vely reported in urology and pathology journals. We studied two cases of malacoplakia that were primarily referred to the department of internal medicine because of fever and abdominal masses. In one patient, malacoplakia was diagnosed in the unusual ovarian location, while in the other patient a large renal mass was found and ciprofloxacin therapy failed because of bacterial resistance. The clinical and radiologic appearance of malacoplakia often mimics that of a malignant tumor. The principal disorder is probably a monocytic-macrophagic bactericidal defect. A definitive diagnosis depends on microscopic detection of Michaelis-Gutmann bodies by means of von Kossa stain. We outlined treatment strategies on the basis of a review of the literature since 1981, which included 140 cases. If possible, immunosuppressive drugs should be stopped. Quinolone antibiotic treatment and surgical excision or incision and drainage lead to the highest cure rates (90% and 81%, respectively). Specific intracellular penetration of quinolone antibiotics is a possible reason for the higher cure rate achieved with these antibiotics. Bethanechol has been suggested to correct the supposed fundamental disturbance by increasing the intrecellular cyclic guanosine monophosphate concentration, but there is still no convincing evidence of its clinical efficacy. [References: 118] Publication Type: Case Reports. Journal Article. Review.
<5> Unique Identifier [PMID]: 2657104 Authors: Long JP Jr. Althausen AF. Institution: Department of Surgery, Massachusetts General Hospital, Boston. Title: Malacoplakia: a 25-year experience with a review of the literature. [Review] [26 refs]
Source: Journal of Urology. 141(6):1328-31, 1989 Jun. Abstract: Our experience with 9 cases of genitourinary malacoplakia is reviewed. The bladder was involved in 4 patients, ureter in 2, prostate in 1, testis in 1 and a combination of prostate, bladder, rectum and pelvic adnexae in 1. The female-to-male ratio was 2:1. Escherichia coli was present in 7 of 8 available urine cultures. Of 9 patients 2 had associated immunocompromised conditions. A variety of therapeutic approaches were chosen, depending mainly on location and extent of disease. These varying combinations of medical and surgical therapies produced resolution of disease in 8 of 9 patients. Generally, upper tract involvement requires surgical intervention, while most cases of lower tract involvement can be managed with antibiotics and endoscopic resection. Rare cases of extensive lower tract malacoplakia may require extirpation for cure. [References: 26] Publication Type: Journal Article. Review.
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Resident Report / Department of Medicine & Grady Branch Library Emory University School of Medicine 2005 Edition Participating Faculty: Carlos Del Rio MD / Joyce Doyle MD / Lorenzo Difrancesco MD / Erich Folch MD / Alicia Hidron MD
Contact:
Karl Woodworth
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