Malakoplakia in the gastrointestinal tract of a liver transplant recipient

Malakoplakia is an uncommon chronic inflammatory disease characterized by tumor-like masses consisting of aggregates of characteristic histiocytes (Von Hasemann histiocytes) with pathognomonic inclusions (Michaelis-Gutmann bodies). Most of the cases reported in the literature, including the first cases in which the typical histiocytes and inclusions were described, involve the genitourinary tract although involvement of gastrointestinal tract, lymph nodes, brain, bone, lungs, adrenal glands, and skin has also been reported. Malakoplakia is considered to be of unknown etiology. However immunodeficiency states, such as in malignancy, renal transplantation, collagen disease, and leukemia, have been remarkably associated with patients with malakoplakia. Interestingly, most of these patients have chronic infections by Escherichia coli. Review of the literature revealed that malakoplakia following liver transplantation has not, to date, been documented. Herein we describe the first case of malakoplakia of the gastrointestinal tract in an immunosuppressed liver transplant recipient.