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Successful use of azithromycin for Escherichia coli–associated renal allograft malakoplakia: a report of two cases

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Abstract

Malakoplakia is a chronic granulomatous disease associated with incomplete clearance of bacterial pathogens. A multimodal approach to therapy includes antimicrobials with intracellular activity, reduction in immunosuppression, and debulking of lesions. Azithromycin has an intracellular mechanism of action and enhanced Gram-negative activity compared to other macrolides. Despite some in vitro data to support its use, there are no clinical breakpoints or epidemiological cut-off values for most Enterobacterales from the European Committee on Antimicrobial Susceptibility Testing (EUCAST) or the Clinical and Laboratory Standards Institute (CLSI). We present two cases, previously unreported, of Escherichia coli associated renal allograft malakoplakia successfully treated with azithromycin.

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Acknowledgements

We thank Dr. Alison Skene (Austin Hospital, Melbourne) for her expertise in reaching a histopathologic diagnosis.

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Authors and Affiliations

  1. Department of Infectious Diseases, Austin Health, 145 Studley Road, Heidelberg, Victoria, 3084, Australia

    Paul M. Kinsella, Olivia C. Smibert & Natasha E. Holmes

  2. Transplant and Immunocompromised Host Infectious Diseases, Infectious Diseases Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA

    Olivia C. Smibert & Camille N. Kotton

  3. Department of Nephrology, Austin Health, Heidelberg, Victoria, 3084, Australia

    John B. Whitlam

  4. Department of Surgery, Austin Health, Heidelberg, Victoria, 3084, Australia

    Mark Steven

  5. Department of Pathology, Massachusetts General Hospital, Boston, MA, 02114, USA

    Ricard Masia

  6. Department of Pharmacy, Massachusetts General Hospital, Boston, MA, 02114, USA

    Ronak G. Gandhi

  7. Department of Medicine and Radiology, The University of Melbourne, Parkville, Victoria, 3010, Australia

    Natasha E. Holmes

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  1. Paul M. Kinsella
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  2. Olivia C. Smibert
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All authors contributed to the writing and critical review of the manuscript.

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Correspondence to Paul M. Kinsella.

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Kinsella, P.M., Smibert, O.C., Whitlam, J.B. et al. Successful use of azithromycin for Escherichia coli–associated renal allograft malakoplakia: a report of two cases. Eur J Clin Microbiol Infect Dis 40, 2627–2631 (2021). https://doi.org/10.1007/s10096-021-04270-x

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  • DOI: https://doi.org/10.1007/s10096-021-04270-x

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