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eISSN 3022-7712

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Korean J Transplant 2022; 36(4): 289-293

Published online December 31, 2022

https://doi.org/10.4285/kjt.22.0048

© The Korean Society for Transplantation

Successful treatment of renal malakoplakia via the reduction of immunosuppression and antimicrobial therapy after kidney transplantation: a case report

Seung Hyuk Yim1,2 , Eun-Ki Min1,2 , Hyun Jeong Kim1,2 , Beom Jin Lim3 , Kyu Ha Huh1,2

1Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
2Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
3Department of Pathology, Yonsei University College of Medicine, Seoul, Korea

Correspondence to: Kyu Ha Huh
Research Institute for Transplantation, Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
Tel: +82-2-2228-2111
Fax: +82-2-313-8289
E-mail: khhuh@yuhs.ac

Received: October 14, 2022; Accepted: November 14, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Malakoplakia is a rare, granulomatous disease that usually affects immunocompromised individuals and is generally associated with poor graft and patient survival. We present a case of renal malakoplakia after kidney transplantation (KT). A 33-year-old female patient with chronic kidney disease underwent living-donor KT at Severance Hospital. The patient was administered 375 mg/m2 rituximab due to high panel reactive antibodies. Immunosuppression was initiated with 1.5 mg/kg anti-thymocyte globulin and intravenous methylprednisolone and maintained with tacrolimus, oral methylprednisolone, and mycophenolate mofetil (MMF). Six months after KT, the patient was hospitalized for a urinary tract infection with an elevated serum creatinine level of 3.14 mg/dL. Renal biopsy revealed malakoplakia involving the renal parenchyma. Upon this diagnosis, the dose of tacrolimus was reduced and MMF was stopped. Fluoroquinolone was used for 16 days, and the trimethoprim/sulfamethoxazole dose was doubled for 6 days. The patient was hospitalized for 3 weeks and closely observed during outpatient visits. Follow-up ultrasonography revealed mass-like lesions of renal malakoplakia, which disappeared 5 months after diagnosis. The serum creatinine level decreased to 1.29 mg/dL 28 months after diagnosis. Our results suggest that renal malakoplakia can be successfully treated by the reduction of immunosuppression and sustained antimicrobial therapy.

Keywords: Malakoplakia, Kidney transplantation, Immunosuppression, Graft rejections, Case report

HIGHLIGHTS
  • We report a case of the successful treatment of malakoplakia via the reduction of immunosuppression and an increase in antibiotic dosage.

  • The standard treatment of malakoplakia has not yet been established; as such, further study is required.