Case Report
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Jun 25, 2025; 14(2): 100530
Published online Jun 25, 2025. doi: 10.5527/wjn.v14.i2.100530
Malakoplakia in kidney transplant recipients: Three case reports
Prathap Kumar Simhadri, Renish Contractor, Deepak Chandramohan, Matthew McGee, Udit Nangia, Mohammad Atari, Syed Bushra, Sanjana Kapoor, Ramya Krishna Velagapudi, Pradeep K Vaitla
Prathap Kumar Simhadri, Internal Medicine/Nephrology, Advent Health, Daytona Beach, FL 32117, United States
Prathap Kumar Simhadri, Renish Contractor, Department of Medicine, FSU College of Medicine, Daytona Beach, FL 32117, United States
Deepak Chandramohan, Department of Nephrology, UAB School of Medicine, Birmingham, AL 35001, United States
Matthew McGee, Department of Medicine, Lark Erie College of Osteopathic Medicine, Bradenton, FL 34205, United States
Udit Nangia, Department of Internal Medicine, University Hospitals-Parma Medical Center, Parma, OH 44129, United States
Mohammad Atari, Syed Bushra, Sanjana Kapoor, Department of Nephrology, University of Mississippi Medical Center, Jackson, MS 39056, United States
Ramya Krishna Velagapudi, Department of Pathology, University of Mississippi Medical Center, Jackson, MS 39056, United States
Pradeep K Vaitla, Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS 39216, United States
Author contributions: Simhadri PK was responsible for conceptualization, wrote the original draft, literature review, and revision; Contractor R and McGee M wrote the original draft; Chandramohan D and Nangia U were responsible for literature review and revision; Atari M, Bushra S, Kapoor S, and Velagapudi RK were responsible for diagnosis, management, content validation, and revision; Vaitla PK was responsible for oversight, activity planning and execution; all of the authors read and approved the final version of the manuscript to be published.
Informed consent statement: An informed consent was obtained from all the patients described in this case series.
Conflict-of-interest statement: All authors do not have any financial or non-financial conflicts of interest concerning this submission.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Prathap Kumar Simhadri, FASN, MD, Associate Professor, Consultant Physician-Scientist, Staff Physician, Internal Medicine/Nephrology, Advent Health, 305 Memorial Medical Parkway, Daytona Beach, FL 32117, United States. prathap.simhadri@gmail.com
Received: August 19, 2024
Revised: February 3, 2025
Accepted: March 4, 2025
Published online: June 25, 2025
Processing time: 233 Days and 9.8 Hours
Abstract
BACKGROUND

Malakoplakia is a rare chronic granulomatous disease associated with gram-negative infection, predominantly by Escherichia coli. It is induced by defective phagolysosomal activity of the macrophages. Malakoplakia commonly affects the urinary bladder but has been shown to affect any solid organ, including the native and transplanted kidney. However, isolated malakoplakia of the kidney allograft is rare. Transplant recipients with compromised immune systems are more likely to develop malakoplakia.

CASE SUMMARY

We report three cases of kidney allograft parenchymal malakoplakia in kidney transplant recipients on immunosuppression that were successfully managed with good outcomes. We described the clinical characteristics of all the kidney allograft malakoplakia cases documented in the literature. A total of 55 cases of malakoplakia were reported in recipients with a history of kidney transplant. A total of 27 recipients had malakoplakia involving the allograft, and others had malakoplakia in other organs. The common presentations included allograft dysfunction, pyelonephritis, and allograft or systemic mass. Most recipients had favorable outcomes with appropriate management that included prolonged antibiotic therapy and adjustment of immunosuppression. We reviewed the published literature on all the cases of malakoplakia in kidney transplant recipients so far and summarized the etiology, management, and outcomes.

CONCLUSION

This case series provides an overview of the etiology, presentation, pathogenesis, and management of malakoplakia in kidney transplant recipients.

Keywords: Renal transplant; Malakoplakia; Allograft malakoplakia; Michaelis-Gutmann bodies; Von Hansemann cells; Transplant malakoplakia; Case report

Core Tip: Patients with an immunosuppressed state, such as renal transplantation, are at increased risk of developing malakoplakia. This disease has varied presentations and is challenging to diagnose. We present our recent experience in the diagnosis and management of malakoplakia in renal transplant recipients. We were able to review the documented cases of malakoplakia among renal transplant recipients in the literature and summarize our findings. We made conclusions concerning its presentation, association with transplant rejection, and management strategies.