Malakoplakia is a chronic granulomatous inflammatory disorder.
Malakoplakia is inflammatory condition which makes its presence known as a papule, plaque or ulceration that generally affects the genitourinary tract. However, it may also be related with other bodily organs. The inflammation is characterized by enlarged, granular macrophages, scattered PMNs, and characteristic concentrically lamellate, calcified structures called Michaelis-Gutman bodies. Microscopically it is characterized by the presence of foamy histiocytes with basophilic inclusions called Michaelis-Gutmann bodies.
Malakoplakia is thought to effect from the inadequate killing of bacteria by macrophages. Therefore, the moderately digested bacteria accumulate in macrophages and leads to a deposition of iron and calcium. The impairment of bactericidal activity manifests itself as the formation of an ulcer, plaque or papule. It most frequently occurs in the genitourinary tract; however, remote cases have been reported in many other organs, including colon, stomach, lung, liver, bone, uterus, and skin. Malakoplakia is related with patients with a history of immunosuppression due to lymphoma, diabetes mellitus and renal transplantation.
Antibiotics are accustomed for treatment of malakoplakia. Antimicrobials directed against gram-negative bacteria, especially E coli, are used to treat patients with malakoplakia. Quinolone antibiotics (e.g., ciprofloxacin) and sulfonamides (e.g., trimethoprim-sulfamethoxazole) are signifying. Bethanechol and ascorbic acid have also been used in the treatment of patients with malakoplakia. Malakoplakia has been reported in patients receiving chemotherapy or immunosuppressive therapy for organ transplantation, as well as various immune deficient states. Therapy with antibiotics that concentrate in macrophages is associated with a high cure rate.
Antibiotic therapy regulate against E coli in combination with surgery provides the best option of cure. Ascorbic acid has been used to increase the cGMP and cyclic adenosine monophosphate levels in monocytes, which may represent an effective strategy for therapy. Surgery combined with antibiotic therapy should be directed against E coli. Vitamins with the ability to induce collagen fibril synthesis are used. Immunosuppressive drug therapy is usually needed to effectively treat malakoplakia. Prevention is better than cure. Immunosuppressive agents should be used with caution in patients with a prior history of malakoplakia.
