Malakoplakia is an uncommon inflammatory condition rarely involving parenchyma of transplan- ted kidney. We report a 44-year-old female recipient of a cadaveric renal allograft treated with cyclosporin A and prednison. After transplantation, E. coli and Citrobacter bacteruria occured and three years later decreased graft function developed. Percutaneous needle biopsy was perfor- med and diagnosis of malakoplakia was established. Histologically, interstitial sheets of plasmo- cytes and histiocytes with periodic acid-Shiff positive cytoplasm containing Michaelis-Gutmann bodies were present. Ultrastructurally, phagolysosomes containing membrane fragments and va- rious developmental stages of inclusions to fully developed Michaelis-Gutmann bodies were found. The patient was treated with co-piperacillin and subsequently pefloxacin and renal functi- ons improved after six months follow-up. Our case suggests that malakoplakia represents an abnormal defective histiocytic response to the infection in the setting of immunosuppressive therapy.

        Key words: malakoplakia-kidney transplantation - diagnosis, kidney disease - pathology - needle