Malakoplakia Associated with Bladder Cancer: A Case Report

Abstract

Malakoplakia is a rare granulomatous inflammatory condition, frequently associated with Escherichia coli infection and immunosuppression, primarily affecting the urinary tract. We report the case of a 49-year-old woman with recurrent E. coli urinary tract infections and symptoms of overactive bladder, whose initial diagnosis of bladder malakoplakia was confirmed by biopsy. She received antibiotic prophylaxis, antimuscarinic therapy, intravesical botulinum toxin injections, and multiple transurethral resections; however, the lesions recurred. In 2023, a new biopsy revealed high-grade papillary urothelial carcinoma with squamous differentiation, representing a rare association not previously described in the literature. The patient underwent radical cystectomy with orthotopic ileal neobladder reconstruction, with good functional recovery and improved quality of life. This case illustrates the diagnostic challenge of malakoplakia due to its clinical and endoscopic similarity to bladder neoplasms and underscores the importance of rigorous follow-up in persistent cases. Periodic endoscopic surveillance and diagnostic reassessment in the presence of recurrent lesions are essential, considering the possibility of neoplasia even after a previous histological diagnosis of malakoplakia, in order to avoid treatment delays and optimize prognosis.