S1690 A Case of Rhodococcus Related Colonic Malakoplakia in a Renal Transplant Patient
Bibliographic record
Abstract
INTRODUCTION: Malakoplakia is a rare disease that involves the gastrointestinal tract. It is seen in immunocompromised patients. Chronic bacterial infections such as Escherichia coli, Proteus mirabilis, and Mycobacterium tuberculosis can lead to malakoplakia. Rarely, rhodococcus Equi, a zoonotic bacterium, is believed to be the infectious culprit. Malakoplakia is diagnosed with tissue biopsy and cultures. We present a case of colonic malakoplakia mimicking malignancy in an immunosuppressed patient with a kidney transplant. CASE DESCRIPTION/METHODS: A 75-years old male patient with a kidney transplant on tacrolimus and prednisone was referred to our department for work-up of iron deficiency anemia. He was also known for hypertension, diabetes, obstructive and atrial fibrillation. He is a farmer and lives in close proximity to live stocks and horses. He has suffered acute antibody rejection shortly after the transplant which required transient intensification of his immunosuppression with Mycophenolic Acid and Immunoglobulin transfusion. A diagnostic colonoscopy revealed extensive flat and polypoid lesions with a nodular pattern in the cecum and proximal colon. The endoscopic appearance was consistent with granular lateral spreading tumor (LST). Biopsies were obtained and pathology have confirmed malakoplakia secondary to rhodococcus infection. He was treated with three months course of Ciprofloxacin resulting in partial resolution. He is currently receiving a prolonged antibiotic course with a planned colonoscopy follow-up. DISCUSSION: Malakoplakia is a rare granulomatous disease that affects many organs including the bladder, brain, lungs, and the colon. It is diagnosed through unique histological features known as Michaelis-Gutmann Bodies (histocytes with cytoplasmic inclusions). Endoscopic features include large nodular sessile or polypoid masses in the colon, which is easily misinterpreted as colonic neoplasia. It is associated with immunosuppression, HIV, malignancy, and chronic infections. However, sporadic cases of healthy subjects were reported. Rhodoccus equi is a gram-positive bacteria mainly known as an animal pathogen known to trigger ulcerative colitis in swine. Transmission to humans occurs through direct contact or inhalation. Clinical presentation is nonspecific and depends on location and size. A case report recorded an acute large bowel obstruction while another manifested as chronic diarrhea and abdominal pain. Treatment is limited to antimicrobial agents and supporting the immune system.Figure 1.: Laterally spreading nodular polypoid lesion occupying one-third of cecal circumfernce.Figure 2.: A second area representing sessile polypoid lesions with central depression.Figure 3.: Colonic biopsy demonstrated histocytes with eosinophilic granular cytoplasm.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.005 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".