ascorbic-acid and Malacoplakia

Malakoplakia is an uncommon inflammatory condition usually affecting the genitourinary tract, which has been associated with infections, tumors, and immunocompromised states. The condition has been reported in many different organs and it may rarely involve the skin. We describe a case of an isolated perianal cutaneous malakoplakia in an immunocompetent 23-year-old Syrian male.

Topics: Anti-Bacterial Agents; Anus Diseases; Anus Neoplasms; Ascorbic Acid; Ciprofloxacin; Combined Modality Therapy; Condylomata Acuminata; Diagnostic Errors; Drug Therapy, Combination; Humans; Immunocompetence; Macrophages; Malacoplakia; Male; Recurrence; Young Adult

The purpose of this article is to review the potential role of nuclear medicine scanning, especially with 67Ga, in the presumptive diagnosis and clinical management of patients with renal parenchymal malacoplakia (RPMP), a rare disease associated with coliform bacterial infection of the kidney and characterized by chronic unresolving inflammatory infiltrates containing von Hansemann macrophages in the renal parenchyma.. Published cases of RPMP were collected from the archival literature by searching the MEDLINE database and by reviewing bibliographic references contained in articles on malacoplakia. Data on the clinical features and radiographic evaluation of patients with RPMP were extracted from the clinical case reports.. Forty-three cases of RPMP published over the past 20 yr were identified. Ten of the 43 patients (23%) had 67Ga scanning as a component of their diagnostic evaluation. In all 10 patients, renal uptake of 67Ga was classified as intense. Two of those 10 patients had serial 67Ga scanning performed to assess response to antibiotic treatment; both patients exhibited decreased uptake or complete resolution of abnormal renal uptake over time, a finding also exhibited by our patient.. Intense renal uptake of 67Ga, typically in the clinical setting of fever, progressive renal failure and nephromegaly, strongly supports a diagnosis of RPMP. In those patients receiving prolonged antimicrobial therapy for RPMP, resolution of abnormal 67Ga uptake over time may provide an objective endpoint for treatment.

Topics: Anti-Infective Agents; Ascorbic Acid; Ciprofloxacin; Citrates; Female; Gallium; Gallium Radioisotopes; Humans; Kidney Diseases; Malacoplakia; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Rifampin

Malacoplakia is a rare inflammatory disorder seen most often in the urinary tract, where it is highly associated with coliform infection. Although first recognized by pathologists in 1902, it has received little attention from the infectious disease community. While there remains much uncertainty regarding the specific cause of malacoplakia, it appears to be associated with a defect in intracellular killing of ingested microorganisms by macrophages. We report a case of bilateral renal parenchymal malacoplakia that presented as fever of unknown origin, and we review 33 previously identified cases. Renal malacoplakia has traditionally been associated with high morbidity and mortality. More recently, treatment with antimicrobial agents such as trimethoprim or ciprofloxacin has yielded a better outcome than had been documented with other therapy. Malacoplakia should be considered in the evaluation of fever of unknown origin or of relapsing or refractory urinary tract infection. Therapy with antimicrobial agents capable of intracellular penetration is recommended.

Topics: Anti-Infective Agents; Ascorbic Acid; Bethanechol; Bethanechol Compounds; Female; Fever of Unknown Origin; Humans; Kidney Diseases; Malacoplakia; Middle Aged; Urinary Tract Infections

We report a case of prostatic malacoplakia in a 68-year-old man complaining of fever, residual urinary sensation and small urinary stream. Culture of the urine showed E. coli and Enterococcus faecalis. Digital examination and transrectal ultrasound of the prostate were most compatible with carcinoma. However, transrectal needle biopsy revealed the histopathological features of malacoplakia. The patient had been treated with trimethoprim-sulfamethoxazole, bethanechol and ascorbic acid for 5 months. Twenty-seven cases of prostatic malacoplakia in the Japanese literature are reviewed.

Topics: Aged; Anti-Bacterial Agents; Ascorbic Acid; Bethanechol; Bethanechol Compounds; Drug Therapy, Combination; Humans; Malacoplakia; Male; Prostatic Diseases; Trimethoprim, Sulfamethoxazole Drug Combination

Malakoplakia is a rare condition characterized by inflammatory masses with specific histological characteristics. These soft tissue masses can mimic tumors and tend to develop in association with chronic or recurrent infections, typically of the urinary tract. A specific defect in innate immunity has been described. In the absence of randomized controlled trials, management is based on an understanding of the biology and on case reports.. Here we describe a case of presacral malakoplakia in a British Indian woman in her late 30s, presenting with complex unilateral foot drop. Four years earlier, she had suffered a protracted episode of intrapelvic sepsis following a caesarean delivery. Resection of her presacral soft tissue mass was not possible. She received empiric antibiotics, a cholinergic agonist, and ascorbic acid. She responded well to medical management both when first treated and following a recurrence of symptoms after completing an initial 8 months of therapy. Whole exome sequencing of the patient and her parents was undertaken but no clear causal variant was identified.. Malakoplakia is uncommon but the diagnosis should be considered where soft tissue masses develop at the site of chronic or recurrent infections. Obtaining tissue for histological examination is key to making the diagnosis. This case suggests that surgical resection is not always needed to achieve a good clinical and radiological outcome.

Topics: Anti-Bacterial Agents; Ascorbic Acid; Female; Humans; Malacoplakia; Peroneal Neuropathies; Reinfection

Malakoplakia is an unusual acquired granulomatous disease that can affect many systems including urogenital tract. It presents a huge diagnostic challenge as it can mimic malignancy. We report a 55-year diabetic woman who presented with history of macroscopic hematuria and right flank pain. On investigations, ultrasound of kidney, ureter and bladder (KUB) showed right hydronephroureter, and CT KUB showed right moderate hydronephroureter and right ureteric stone. Endoscopic examination revealed multiple white plaques involving urinary bladder and right ureter. The diagnosis of malakoplakia was based on microscopic findings that are specific for its diagnosis.

Topics: Anti-Bacterial Agents; Ascorbic Acid; Biopsy; Cystoscopy; Female; Hematuria; Humans; Malacoplakia; Middle Aged; Tomography, X-Ray Computed; Ultrasonography; Ureter; Urinary Bladder

Malacoplakia is a rare chronic inflammatory disease that most commonly involves the genitourinary tract with a wide spectrum of clinical presentation.. A 65-year-old woman presented with obstructive nephropathy with bilateral hydroureteronephrosis. Bilateral nephrostomy-tube placement saw an improvement in her renal function. A computerized tomography (CT) scan with contrast showed suspect lesions in the bladder, which were confirmed by cystoscopy. A transurethral resection of the suspect areas of bladder on histological examination confirmed the diagnosis of malacoplakia. Bilateral ureteral recanalization was performed with placement of ureteral stents, after balloon dilation of strictures. The treatment was continued with ascorbic acid 500 mg daily and ciprofloxacin 500 mg once daily.. Malacoplakia is a rare disease. Treatment is not standard and depends on the disease location. Malacoplakia that is isolated to the lower genitourinary tract, after a transurethral resection indicating to obtain a biopsy and debulking, can typically be treated with medication, whereas upper tract disease commonly requires a combination of medical and surgical intervention.

Topics: Aged; Anti-Bacterial Agents; Ascorbic Acid; Ciprofloxacin; Female; Humans; Hydronephrosis; Malacoplakia; Renal Insufficiency; Stents; Treatment Outcome; Urinary Bladder; Urinary Catheterization; Urinary Tract Infections; Vitamins

Topics: Anti-Bacterial Agents; Antioxidants; Ascorbic Acid; Bethanechol; Biopsy; Diagnosis, Differential; Female; Fluoroquinolones; Humans; Ill-Housed Persons; Kidney; Kidney Function Tests; Malacoplakia; Middle Aged; Muscarinic Agonists; Organ Size; Prognosis; Renal Dialysis; Renal Insufficiency; Substance-Related Disorders; Tomography, X-Ray Computed; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Cerebral malakoplakia is a very rare chronic inflammatory disease. We herein report the case of a 49-year-old female who presented with a slowly progressive speech disturbance and right hemiparesis. Computed tomography and magnetic resonance imaging showed irregular enhanced mass lesions with numerous scattered areas of calcification in the left insula, thalamus and basal ganglia. Histopathologically, the biopsy specimen showed basophilic laminated inclusion bodies and intracellular and extracellular calculospherules, usually with a typical targetoid appearance (Michaelis-Gutmann bodies). Treatment with antibiotics, bethanechol and ascorbic acid improved her symptoms in association with a decrease in the abnormal calcification and enhancement. The cerebral malakoplakia mimicked a brain tumor in terms of the patient's clinical course and neuroradiological image findings; however, it was successfully cured with medical treatment. This case provides evidence that the pathogenesis of cerebral malakoplakia is deeply tied to bacterial infection and that medical treatment is effective in cases of this disease.

Topics: Anti-Bacterial Agents; Ascorbic Acid; Bethanechol; Brain; Calcinosis; Female; Humans; Inclusion Bodies; Malacoplakia; Middle Aged; Muscarinic Agonists; Vitamins

Malakoplakia is an inflammatory granulomatous disease induced by defective phagocytic activity of macrophage. Malakoplakia is histologically characterized by the presence of Michaelis-Gutmann bodies in macrophages. Although not uncommon in the genito-urinary tract, isolated malakoplakia of the kidney is rarely found. Its main clinical presentation associates acute renal failure and acute pyelonephritis. The clue for diagnosis of renal malakoplakia is based on renal biopsy showing Michaelis-Gutmann bodies. Establishing the diagnosis of renal malakoplakia is essential as it determines the choice of antibiotics and duration of treatment. Prognosis remains poor, leading frequently to chronic renal failure. In this paper, we report four cases of renal malakoplakia and discuss clinical presentation, biological and pathological features, treatment and prognosis of this disease.

Topics: Aged; Anti-Bacterial Agents; Ascorbic Acid; Biopsy; Diabetic Nephropathies; Drug Therapy, Combination; Fatal Outcome; Female; Glucocorticoids; Humans; Kidney Diseases; Liver Cirrhosis; Macrophages; Malacoplakia; Male; Middle Aged; Renal Dialysis; Renal Insufficiency; Risk Factors; Treatment Outcome; Vitamins

We report a case of malacoplakia in the ureter and bladder. A 78-year-old woman was admitted to our department for detailed examination of hydronephrosis. A small-fingertip-sized tumorous yellowish white lesion was detected by cytoscopy at a site that appeared to be the right side of the ureteral orifice. Transurethral resection was performed on the same site. Flat yellowish white protruding lesions were seen at two sites on the right ureter. Michaelis-Gutmann bodies were observed in biopsy specimens from both the bladder and ureter, and a diagnosis of malacoplakia was made. Ascorbic acid and bethanechol chloride were administered postoperatively. Endoscopy performed three months after the operation showed that the protruding lesions in the bladder and ureter had disappeared. Narrowing of the ureter or vesicoureteral reflux has not been seen to date.

Topics: Aged; Ascorbic Acid; Bethanechol Compounds; Drug Therapy, Combination; Female; Humans; Hydronephrosis; Malacoplakia; Ureteral Diseases; Urinary Bladder Diseases

Positron emission tomography is increasingly used for the diagnosis of occult infection or malignancy. The altered metabolic rate of cells in areas of malignancy or infection provides a sensitive method to identify pathology that is otherwise not identified by standard imaging methods. This case report describes a patient who presented with a pyrexia of unknown origin and renal impairment. She had a positron emission tomography scan that showed intense accumulation of fluoro-deoxy-glucose in both kidneys. Subsequent renal biopsy results showed a diagnosis of malacoplakia, the treatment of which resulted in a resolution of the fever and a stabilization of renal function. This is the first report of the positron emission tomographic appearance of renal malacoplakia.

Topics: Abdominal Pain; Ascorbic Acid; Female; Fever of Unknown Origin; Fluorodeoxyglucose F18; Gastrointestinal Diseases; Hematuria; Humans; Kidney Diseases; Malacoplakia; Middle Aged; Radiopharmaceuticals; Tomography, Emission-Computed; Trimethoprim

Topics: Anti-Bacterial Agents; Ascorbic Acid; Child; Colonic Diseases; Female; Humans; Kidney Diseases; Malacoplakia; Nutrition Disorders; Parenteral Nutrition; Rectal Diseases

Topics: Ascorbic Acid; Bethanechol Compounds; Humans; Malacoplakia; Male; Middle Aged; Trimethoprim; Urologic Diseases

Malacoplakia is a granulomatous disease that most frequently involves the urinary tract but also may involve the genital tract, gastrointestinal tract and retroperitoneum. It is believed to be infectious in origin, secondary to a deficiency of intracellular lysosomal digestion, and heretofore considered a chronic problem. We report a case of malacoplakia of the bladder, which was treated successfully with a combination of bethanechol, trimethoprim-sulfamethoxazole and ascorbic acid.

Topics: Anti-Infective Agents, Urinary; Ascorbic Acid; Bethanechol; Bethanechol Compounds; Drug Combinations; Drug Therapy, Combination; Female; Humans; Malacoplakia; Middle Aged; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder Diseases

Topics: Adult; Anti-Bacterial Agents; Ascorbic Acid; Bethanechol Compounds; Chronic Disease; Escherichia coli Infections; Female; Humans; Malacoplakia; Urinary Tract Infections

Topics: Ascorbic Acid; Bethanechol; Bethanechol Compounds; Biopsy; Drug Therapy, Combination; Female; Humans; Malacoplakia; Middle Aged; Urinary Bladder; Urinary Bladder Diseases

Topics: Adult; Ascorbic Acid; Cell Nucleus; Cystoscopy; Eosinophils; Epithelial Cells; Female; Histiocytes; Humans; Hydronephrosis; Kidney Pelvis; Lymphocytes; Malacoplakia; Methenamine; Neutrophils; Plasma Cells; Ureteral Obstruction; Urinary Bladder; Urinary Bladder Diseases; Urography