Malakoplakia in lung transplant recipients: case series

Abstract

Malakoplakia is a rare granulomatous inflammatory disorder caused by impaired macrophage bactericidal activity, most often occurring in immunocompromised patients and commonly associated with chronic bacterial infection. Reports in lung transplant recipients remain limited. Methods We performed a retrospective review of lung transplant recipients diagnosed with malakoplakia at our center. Clinical presentation, microbiology, management strategies, and outcomes were analyzed descriptively. Results Five lung transplant recipients developed 6 episodes of malakoplakia between 5 and 19 months post-transplant. Organ involvement was heterogeneous and included bladder, lung, sigmoid colon, mesenteric lymph nodes, vulvar and labial soft tissues, and prostate. One patient experienced recurrent pulmonary malakoplakia 77 months after the initial episode, representing the first reported recurrence in a solid organ transplant recipient. Chronic bacterial infection was present in all cases. Conclusions Malakoplakia is an uncommon but important complication after lung transplantation with diverse clinical presentations and potential for recurrence. Early tissue diagnosis, targeted antimicrobial therapy, and individualized immunosuppression adjustment are critical for optimal management.