Renal graft malakoplakia masquerading post-transplant lymphoproliferative disorder

BMJ Case Rep. 2021 Aug 16;14(8):e244228. doi: 10.1136/bcr-2021-244228.

Abstract

A 45-year-old woman presented to us in March 2019 with complaints of fever and right lower quadrant abdominal pain for 1 month. She had undergone renal transplantation in 2017 for end-stage renal disease and developed four episodes of urinary tract infection in the next 16 months post transplantation, which were treated based on culture reports. She was subsequently kept on long-term prophylaxis with trimethoprim and sulfamethoxazole. Her present laboratory parameters showed a normal blood picture and elevated creatinine. Urine culture grew Escherichia coli Non-contrast CT of the abdomen-pelvis revealed an endo-exophytic hyperdense mass in the graft kidney showing local infiltration and associated few regional lymph nodes. PET-CT revealed the soft-tissue mass and regional lymph nodes to be hypermetabolic, raising the possibility of lymphoma. However, biopsy showed features of malakoplakia. She was subsequently initiated on long-term antibiotic therapy and her immunosuppression decreased.

Keywords: malignant disease and immunosuppression; renal system; renal transplantation; urinary and genital tract disorders; urinary tract infections.

Publication types

  • Case Reports

MeSH terms

  • Female
  • Humans
  • Kidney Transplantation* / adverse effects
  • Lymphoproliferative Disorders* / diagnosis
  • Lymphoproliferative Disorders* / etiology
  • Malacoplakia* / diagnosis
  • Malacoplakia* / etiology
  • Middle Aged
  • Positron Emission Tomography Computed Tomography
  • Urinary Tract Infections*