{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T02:28:28Z","timestamp":1786328908466,"version":"build-2736575974"},"reference-count":25,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T00:00:00Z","timestamp":1786147200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Background: Malakoplakia is a rare chronic granulomatous inflammatory disorder characterized by defective macrophage phagolysosomal activity and accumulation of Michaelis\u2013Gutmann bodies on histopathology. It occurs predominantly in immunocompromised individuals and may mimic infectious, inflammatory, or neoplastic processes, creating significant diagnostic challenges. We describe four cases of malakoplakia occurring in distinct immunocompromised states and review the published literature to better characterize its clinical spectrum, management, and outcomes. Methods: We conducted a retrospective case series of four patients diagnosed with histologically confirmed malakoplakia at our institution. Cases occurred in the setting of liver transplantation, kidney transplantation, relapsed acute myeloid leukemia, and ulcerative colitis treated with immunosuppressive therapy. A literature review was performed using PubMed and Google Scholar to identify published cases of malakoplakia in immunocompromised hosts. Demographic, clinical, microbiological, therapeutic, and outcome data were extracted and analyzed descriptively. Results: Four patients with malakoplakia involving the gastrointestinal tract or renal allograft were identified. Clinical presentations ranged from incidental endoscopic findings and tumor-like colonic masses to recurrent bacteremia and graft dysfunction. Histopathologic examination demonstrated characteristic Michaelis\u2013Gutmann bodies in all cases. Management included antimicrobial therapy, observation, and surgical intervention when necessary. Two patients achieved complete clinical and histologic resolution, one required transplant nephrectomy because of persistent allograft infection, and one died from progressive acute myeloid leukemia. Combined with 48 cases identified in the literature, 52 patients were analyzed. The gastrointestinal tract was the most frequently affected site (76.9%), followed by the genitourinary tract (19.2%). Malignancy (32.7%), solid-organ transplantation (26.9%), and autoimmune disease (21.2%) were the most common underlying conditions. Conclusions: Malakoplakia should be considered in the differential diagnosis of mass lesions, persistent infections, and inflammatory lesions in immunocompromised patients, particularly those with malignancy or receiving immunosuppressive therapy. Early histopathologic diagnosis is essential to distinguish malakoplakia from malignancy and guide appropriate management. Our findings highlight the heterogeneous clinical manifestations and outcomes of this uncommon condition and emphasize the importance of multidisciplinary evaluation in affected patients.<\/jats:p>","DOI":"10.3390\/diseases14080284","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T01:20:03Z","timestamp":1786324803000},"page":"284","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Malakoplakia in Immunocompromised Hosts: A Case Series and Literature Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0534-7612","authenticated-orcid":false,"given":"Ahmed","family":"Bishara","sequence":"first","affiliation":[{"name":"Schulich School of Medicine & Dentistry, Western University, London, ON N6A 5C1, Canada"},{"name":"Division of Infectious Diseases, Western University, London, ON N6A 4V2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0939-6147","authenticated-orcid":false,"given":"Huma","family":"Saeed","sequence":"additional","affiliation":[{"name":"Schulich School of Medicine & Dentistry, Western University, London, ON N6A 5C1, Canada"},{"name":"Division of Infectious Diseases, Western University, London, ON N6A 4V2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Layan","family":"Akkielah","sequence":"additional","affiliation":[{"name":"Schulich School of Medicine & Dentistry, Western University, London, ON N6A 5C1, Canada"},{"name":"Division of Infectious Diseases, Western University, London, ON N6A 4V2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noor","family":"BuMurah","sequence":"additional","affiliation":[{"name":"Schulich School of Medicine & Dentistry, Western University, London, ON N6A 5C1, Canada"},{"name":"Division of Infectious Diseases, Western University, London, ON N6A 4V2, Canada"},{"name":"Division of Infectious Diseases, Department of Internal Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David K.","family":"Driman","sequence":"additional","affiliation":[{"name":"Schulich School of Medicine & Dentistry, Western University, London, ON N6A 5C1, Canada"},{"name":"Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON N6A 5A5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Silverman","sequence":"additional","affiliation":[{"name":"Schulich School of Medicine & Dentistry, Western University, London, ON N6A 5C1, Canada"},{"name":"Division of Infectious Diseases, Western University, London, ON N6A 4V2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2410-6788","authenticated-orcid":false,"given":"Reza","family":"Rahimi Shahmirzadi","sequence":"additional","affiliation":[{"name":"Schulich School of Medicine & Dentistry, Western University, London, ON N6A 5C1, Canada"},{"name":"Division of Infectious Diseases, Western University, London, ON N6A 4V2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"100530","DOI":"10.5527\/wjn.v14.i2.100530","article-title":"Malakoplakia in kidney transplant recipients: Three case reports","volume":"14","author":"Simhadri","year":"2025","journal-title":"World J. 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