膀胱軟化斑合併大腸桿菌感染：病例報告及文獻探討
何岩1、溫玉清1,2、陳甫綸1、林雍偉1,2
臺北市立萬芳醫院-委託財團法人臺北醫學大學辦理 泌尿科
Malacoplakia of the Urinary Bladder with Escherichia Coli Infection: A Case Report and Review of the Literature
Yen Ho1, Yu-Ching Wen1,2, Fu-Lun Chen1, Yung-Wei Lin1,2
Department of Urology, Taipei Municipal Wan Fang Hospital1
Department of Urology, School of Medicine, College of Medicine, Taipei Medical University2
Background: Malakoplakia is a rare chronic granulomatous inflammatory disease. We hereby present an unusual case of a female diagnosed as malakoplakia of urinary bladder and successful treatment course.
Case Report: This 65-year-old woman has underlying disease of hypertension, dyslipidemia, and Parkinson's disease. Left psoas muscle abscess with urinary tract infection was found and she was admitted for pigtail drainage as well as antibiotic administration. Culture report of abscess drainage and urine revealed Escherichia coli. She was discharged after undergone 4 weeks of intravenous antibiotic treatment(Ceftriaxone then cephalosporin). She was referred to the urology department due to bladder wall thickening noted via computerized tomography (CT) scan. Cystoscopy revealed multiple caseating lesions around whole bladder wall. Transurethral laser en-bloc resection of bladder tumors (TURBT) were carried out. Pathology report revealed picture of malakoplakia with aggregates of epithelioid histiocyte containing numerous Michaelis-Gutmann bodies, which were highlighted by Periodic Acid-Schiff(PAS), Von-Kossa, and iron stains. Antibiotic treatment with first-generation cephalosporin was administered peri-operatively. The patient tolerated the whole treatment course well and the follow-up cystoscopy 6 months afterwards showed no signs of relapse with well recovery of bladder mucosa.
Discussion: Malakoplakia is a rare inflammatory disease that was first accurately described by Hansemann in 1903. It can affect different organs but bladder is one of the most frequently associated ones, particularly in female patients. While the exact etiology is poorly understood, Escherichia coli seems to be the most common organism associated. According to previous reports, malakoplakia is typically associated with acquired immunosuppression and has been described in patients with human immunodeficiency virus (HIV), organ transplants, malignancy, diabetes mellitus, hepatitis C, and sarcoidosis. It has been demonstrated that the bactericidal capacity of macrophages is defective in malakoplakia patients.
Given that malakoplakia is rather rare, large clinical trials and evidence reporting successful treatment are both lacking. General principles of treatment include systemic antibiotics, surgical excision, and limiting immunosuppression. Previous studies suggested that combination of surgical therapy and quinolone antibiotic therapy may be the most effective treatment approach. In individuals treated with surgery with or without antibiotics, there has been a reported 81% cure rate.
Conclusion: We present this case of malakoplakia of urinary bladder complicated psoas abscess infection that underwent successful combination therapy of antibiotic administration and surgical resection.