ABSTRACT
Malakoplakia is a rare, granulomatous disorder that is typically triggered by infections in immunocompromised patients. Although it most commonly affects the urinary tract, cases may occasionally occur in the gastrointestinal tract. There are case reports of malakoplakia of the pancreas with associated pathologic description, but none with detailed imaging and endoscopic findings. In addition, description of magnetic resonance imaging characteristics of mass-forming malakoplakia in the literature is sparse. We present a case of pancreaticoduodenal malakoplakia in an immunocompromised patient, including detailed description of magnetic resonance imaging, computed tomography, and endoscopic findings with radiology-pathology correlation. Classic pathologic features of malakoplakia (eg, hypercellularity, inflammation, and mineralization of Michaelis-Gutmann bodies) lead to specific features on imaging, such as marked diffusion restriction, heterogeneous enhancement, calcification, and increased attenuation on nonenhanced computed tomography. These features may help differentiate malakoplakia from other more common lesions that occur in this location, especially if present in an immunocompromised patient.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde , Duodenal Diseases/diagnosis , Malacoplakia , Multimodal Imaging , Pancreatic Diseases/diagnosis , Aged , Biopsy , Diagnosis, Differential , Duodenal Diseases/immunology , Duodenal Diseases/therapy , Endosonography , Humans , Immunocompromised Host , Magnetic Resonance Imaging , Male , Pancreatic Diseases/immunology , Pancreatic Diseases/therapy , Predictive Value of Tests , Tomography, X-Ray ComputedABSTRACT
Candida species (Candida spp.) infection following total hip arthroplasty (THA) is a rare but potentially devastating complication. The purpose of this study was to provide an evidence-based summarization of the treatment and outcome of Candida spp. infection after THA. We conducted a systemic review of the literature and pooled analysis of Candida spp. infection after THA published between 1950 and 2014. A total of 20 articles with 37 patients were identified. Median time between THA and readmission for Candida spp. infection was 25 months (range 0.5-184 months). Thirty-two patients (87%) underwent removal of the prosthesis for initial surgical treatment. All patients were treated with systemic antifungal medication therapy for various durations after the surgical procedure or primary therapy without surgical procedures except for one patient who was treated with only amphotericin B joint cavity irrigation after removal of the prosthesis. Relapse of the infection occurred in three patients who had retention of the original prosthesis. There were three deaths related to the Candida spp. infection following THA owing to uncontrolled Candida spp. infection and deteriorating candidemia sepsis. Of note, among 15 patients who underwent two-stage exchange arthroplasty, there was one patient (7%) who developed complication (death) while other 14 patients had uncomplicated recovery. In conclusion, surgical debridement with removal of the original prosthesis or two-stage exchange arthroplasty with combination of adequate systemic antifungal therapy is highly recommended in the treatment of Candida spp. infection following THA.