RT Journal
A1 van der Voort PJ, ten Velden JM, Wassenaar RP, Silberbusch J
T1 Malacoplakia: Two case reports and a comparison of treatment modalities based on a literature review
JF Archives of Internal Medicine
JO Archives of Internal Medicine
YR 1996
FD March 11
VO 156
IS 5
SP 577
OP 583
DO 10.1001/archinte.1996.00440050137015
UL http://dx.doi.org/10.1001/archinte.1996.00440050137015
AB Malacoplakia is a rare infectious disease that has been almost exclusively reported in urology and pathology journals. We studied two cases of malacoplakia that were primarily referred to the department of internal medicine because of fever and abdominal masses. In one patient, malacoplakia was diagnosed in the unusual ovarian location, while in the other patient a large renal mass was found and ciprofloxacin therapy failed because of bacterial resistance. The clinical and radiologic appearance of malacoplakia often mimics that of a malignant tumor. The principal disorder is probably a monocytic-macrophagic bactericidal defect. A definitive diagnosis depends on microscopic detection of Michaelis-Gutmann bodies by means of von Kossa stain. We outlined treatment strategies on the basis of a review of the literature since 1981, which included 140 cases. If possible, immunosuppressive drugs should be stopped. Quinolone antibiotic treatment and surgical excision or incision and drainage lead to the highest cure rates (90% and 81%, respectively). Specific intracellular penetration of quinolone antibiotics is a possible reason for the higher cure rate achieved with these antibiotics. Bethanechol has been suggested to correct the supposed fundamental disturbance by increasing the intracellular cyclic guanosine monophosphate concentration, but there is still no convincing evidence of its clinical efficacy.(Arch Intern Med. 1996;156:577-583)