Cutaneous malacoplakia: A report of two cases and review of the literature

• Published in: Journal of the American Academy of Dermatology Vol. 34; no. 2; pp. 325 - 332
• Main Authors: Lowitt, Mark H., Kariniemi, Arja-Leena, Niemi, Kirsti Maria, Kao, Grace F.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.02.1996; Elsevier
• Subjects: Aged; Biological and medical sciences; Dermatology; Histiocytes - ultrastructure; Humans; Immunocompromised Host; Immunosuppression; Inclusion Bodies - ultrastructure; Kidney Transplantation - immunology; Macrophages - ultrastructure; Malacoplakia - epidemiology; Malacoplakia - immunology; Malacoplakia - pathology; Male; Medical sciences; Microscopy, Electron; Middle Aged; Pigmentary diseases of the skin; Skin - ultrastructure; Skin Diseases - epidemiology; Skin Diseases - immunology; Skin Diseases - pathology; Case study; Human; Skin disease; Skin; Malacoplakia; Bibliographic survey
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/S0190-9622(07)80002-8

Malacoplakia, an inflammatory disease characterized by accumulations of phagocytic macrophages, occurs primarily in immunocompromised individuals. Cutaneous involvement is rare. Two men, each with a renal allograft, had expanding nodules on the temple and perianal area (case 1) and perianal, inguinal, and scrotal skin (case 2). Lesions resolved after combined surgical and antibiotic therapy. Histopathologic examination showed dense infiltration with large phagocytic macrophages containing round, concentric, laminar Von Kossa stain-positive inclusion bodies. Histiocytes had positive results for CD 68, lysozyme, and α 1-antitrypsin. Electron microscopic examination demonstrated rare intracytoplasmic inclusion bodies with concentric electron-dense laminations of calcium (Michaelis-Gutmann bodies.) Cutaneous malacoplakia should be considered in the differential diagnosis of nodules or draining ulcers, particularly in immunocompromised patients. Because Michaelis-Gutmann bodies are difficult to identify, specimens should be evaluated for cutaneous malacoplakia by immunohistochemical or electron microscopic means.