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KMID : 0351219930250030277
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Korean Journal of Infectious Diseases
1993 Volume.25 No. 3 p.277 ~ p.281
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A Case of Renal Parenchymal Malakoplakia associated with E. Coli Empyema
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정상식
주용선/진재용/정두련/문희범/김광훈/송재훈
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Abstract
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Malakoplakia is a relatively rare chronic inflammatory disease, usually involving the bladder and upper urinary tract. It represents a peculiar inflammatory response to infection by gram negative bacteria, most frequently by E. coli. Malakoplakia
is
characterized by the presence of large histiocytes called "von Hansemann cells" and small basophilic inclusion called "Michaelis-Gutmann bodies".
We report a case of malakoplakia involving renal parenchyme and perinephric space, also associated with E. coli empyema. The patient was a 66-year-old female with a long history of steroid treatment for rheumatoid arthritis. The patient also had
a
history of diabetes mellitus. The patient was admitted to the Asan medical Center because of high fever and pleuritic pain of right chest. The chest X-ray showed pleural effusion on right chest. which was characterized by low pH (6.3), markedly
increased WBC count (63360/ml, poly 94%) and increased LDH level (43643 (ICU) on thoracentesis. The culture of pleural fluid revealed E. coli, which was sensitive to cefazolin and gentamicin. The chest and abdominal CT scan showed huge mass
shadow
extending extending from right diaphragm to posterior aspect of right kidney as well as pleural effusion on right chest. Despite prolonged therapy with cefazolin and gentamicin. mass shadow progrssively increased in size. PCNB showed typical
Michaelis-Gutmann bodies suggestive of malakoplakia. Ultimately, the patient was treated with sugical resection and prolonged course of parenteral antibiotics.
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KEYWORD
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