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Renal graft malakoplakia masquerading post-transplant lymphoproliferative disorder
  1. Manas Ranjan Patel1,
  2. Venkatesh Thammishetti1,
  3. Surabhi Agarwal2 and
  4. Hira Lal3
  1. 1Department of Nephrology, SGPGIMS, Lucknow, Uttar Pradesh, India
  2. 2Department of Radiology, SGPGIMS, Lucknow, Uttar Pradesh, India
  3. 3Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
  1. Correspondence to Dr Hira Lal; hiralal2007{at}


A 45-year-old woman presented to us in March 2019 with complaints of fever and right lower quadrant abdominal pain for 1 month. She had undergone renal transplantation in 2017 for end-stage renal disease and developed four episodes of urinary tract infection in the next 16 months post transplantation, which were treated based on culture reports. She was subsequently kept on long-term prophylaxis with trimethoprim and sulfamethoxazole. Her present laboratory parameters showed a normal blood picture and elevated creatinine. Urine culture grew Escherichia coli. Non-contrast CT of the abdomen-pelvis revealed an endo-exophytic hyperdense mass in the graft kidney showing local infiltration and associated few regional lymph nodes. PET-CT revealed the soft-tissue mass and regional lymph nodes to be hypermetabolic, raising the possibility of lymphoma. However, biopsy showed features of malakoplakia. She was subsequently initiated on long-term antibiotic therapy and her immunosuppression decreased.

  • malignant disease and immunosuppression
  • renal system
  • urinary and genital tract disorders
  • renal transplantation
  • urinary tract infections

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  • Contributors MRJ, VT and SA conducted the study including patient recruitment, data collection and data analysis. VT and SA did the literature review and prepared the manuscript draft. All the authors had complete access to study data. The manuscript was finally reviewed by MRJ and HL.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.