case_images: PMC10949541_01
case_images: Timeline of clinical course post-transplant. The text in orange at the top of the figure includes immunosuppression medications. The text in green at the bottom of the figure denotes antimicrobial therapies.. C. difficile: Clostridioides difficile; EAEC: enteroaggregative Escherichia coli; E. coli: Escherichia coli; EGD: esophagogastroduodenoscopy; FSGS: focal segmental glomerulonephritis; GIPP: gastrointestinal pathogen panel; POD: postoperative day; PTA: prior to admission.. *E. coli isolates susceptible to cefepime, meropenem, amikacin, gentamicin, tobramycin, and trimethoprim/sulfamethoxazole and resistant to ceftriaxone, ciprofloxacin, and levofloxacin.. **E. coli isolates susceptible to cefepime, meropenem, amikacin, gentamicin, tobramycin, and resistant to ceftriaxone, ciprofloxacin, levofloxacin, and trimethoprim/sulfamethoxazole.
case_images: 10.1177_2050313X241239866-fig1.jpg
case_images: PMC10949541_01_10.1177_2050313X241239866-fig1.jpg
case_images: fig1-2050313X241239866
case_images: The stool was persistently positive for norovirus and enteroaggregative Escherichia coli (E. coli; EAEC) starting at 11- and 7-month PTA, respectively (Figure 1).
case_images: Colonoscopy and histopathologic findings of malakoplakia. (a) Diffuse blanching nodularity of the colon. (b) Grossly normal colonic mucosa. (c) White macular lesions in the colonic mucosa. (d) Panel D: Inset shows a lower power view of the colonic biopsy with mucosal expansion with sheets of histiocytes (HE, 40x). Panel D shows multiple concentrically layered or targetoid, basophilic inclusions, 2-10 microm in diameter thought to represent remnants of phagolysosomes mineralized by iron and calcium, as indicated by red arrows (H&E, 600x). Panel E: Normal colonic biopsy with complete resolution of malakoplakia (H&E, 40x). Panel F: Mucosal biopsy showing similar basophilic inclusions as indicated by red arrows (H&E, 600x). Panel F inset: These inclusions are referred to as Michaelis-Gutman bodies and are highlighted by a calcium stain, von Kossa (400x).
case_images: 10.1177_2050313X241239866-fig2.jpg
case_images: PMC10949541_01_10.1177_2050313X241239866-fig2.jpg
case_images: fig2-2050313X241239866
case_images: He underwent a colonoscopy on hospital day 2 which showed diffuse sessile polyposis from the sigmoid colon to the rectum (Figure 2). Histopathology from colonic biopsies revealed diffuse malakoplakia as evidenced by lamina propria expansion due to the proliferation of histiocytes containing laminated mineralized concretions called Michaelis-Gutman bodies (Figure 2).