Leão C A, Duarte M I S, Gamba C, Ramos J F, Rossi F, Galvão M M, David-Neto E, Nahas W, Shikanai-Yasuda M A, Pierrotti L C
Infections in Immunocompromised Hosts Group, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil.
Transpl Infect Dis. 2012 Dec;14(6):E137-41. doi: 10.1111/tid.12012. Epub 2012 Oct 2.
Malakoplakia is a rare chronic granulomatous disease of unknown cause. It is thought to be caused by an acquired bactericidal defect of macrophages. Malakoplakia is associated with chronic infections and immunosuppression. Although it occurs mainly in the urinary tract, it has already been reported in almost every organ system. The isolation of bacteria, especially Escherichia coli, is common in malakoplakia patients. Here, we present a case of primary cutaneous malakoplakia in a kidney transplant recipient who had been taking prednisone, tacrolimus, and mycophenolate. Culture of a lesion grew Burkholderia cepacia complex. Treatment with high doses of trimethoprim-sulfamethoxazole was successful. We also present a systematic review of the literature, identifying 4 previously reported cases of malakoplakia after renal transplantation under similar immunosuppressive therapy, most occurring in the urinary tract or perineum and following benign courses to cure. Data in the literature suggest that malakoplakia has become even rarer since changes were made in the immunosuppressive therapy employed after kidney transplantation.
软斑病是一种病因不明的罕见慢性肉芽肿性疾病。它被认为是由巨噬细胞获得性杀菌缺陷引起的。软斑病与慢性感染和免疫抑制有关。虽然它主要发生在泌尿系统，但几乎在每个器官系统中都有报道。在软斑病患者中，细菌的分离，尤其是大肠杆菌，很常见。在此，我们报告一例肾移植受者原发性皮肤软斑病病例，该患者一直在服用泼尼松、他克莫司和霉酚酸酯。病变培养物中生长出洋葱伯克霍尔德菌复合体。高剂量甲氧苄啶-磺胺甲恶唑治疗成功。我们还对文献进行了系统回顾，确定了4例先前报道的在类似免疫抑制治疗下肾移植后发生软斑病的病例，大多数发生在泌尿系统或会阴，病程良性并治愈。文献数据表明，自从肾移植后免疫抑制治疗发生改变以来，软斑病变得更加罕见。
