Renal Malakoplakia Caused by Klebsiella pneumoniae in a Transplanted Kidney: A Case Report
Abstract
Malakoplakia is a rare chronic inflammatory disease resulting from defective bactericidal activity of macrophages following bacterial infection. The most common causative pathogen is Escherichia coli. This condition predominantly affects immunocompromised individuals, particularly those who have undergone kidney transplantation. Malakoplakia is commonly diagnosed histopathologically based on the presence of Michaelis-Gutmann bodies with typical targetoid structures. In this study, we report a case of malakoplakia caused by Klebsiella pneumoniae in a kidney transplant recipient who presented with a urinary tract infection accompanied by acute kidney injury. To our knowledge, no prior case of renal malakoplakia solely attributed to K pneumoniae in a kidney transplant recipient has been reported. Kidney biopsy revealed numerous periodic acid-Schiff (PAS)-positive globules in the tubulointerstitial area. CD68 immunostaining with PAS counterstain demonstrated that the PAS-positive globules were localized within the cytoplasm of CD68-positive histiocytes (ie, von Hansemann cells). Michaelis-Gutmann bodies were observed using Berlin blue staining. The patient was treated with trimethoprim-sulfamethoxazole, and kidney function stabilized. In kidney transplant recipients, the presence of PAS-positive globules in kidney biopsy specimens should prompt consideration of renal parenchymal malakoplakia in the differential diagnosis. Special stains, such as von Kossa and Berlin blue, are…
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