Malacoplakia presenting with obstructive nephropathy with bilateral ureter involvement.

BACKGROUND: A 48-year-old woman with chronic urinary tract infections presented with uremia. Imaging studies revealed bilateral hydronephrosis and segmental ureteral thickening. INVESTIGATIONS: Physical examination, urine and blood analysis, radiography of the chest, chest CT, abdominal and pelvis CT, renal ultrasonography, cystoscopy, anterograde pyelogram, bladder biopsy. DIAGNOSIS: Malacoplakia involving bilatateral ureters and bladder; cavitary pneumonia. MANAGEMENT: Hemodialysis, placement of bilateral percutaneous nephrostomy tubes, administration of ciprofloxacin, ascorbic acid and bethanechol.