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Tuesday Poster Session

Category: Colon

P4605 - A Rare Case of "Malignant” Gastrointestinal Malakoplakia in the Setting of Systemic Lupus Erythematous

Tuesday, October 28, 2025
10:30 AM - 4:00 PM MT
Location: Exhibit Hall
Dhanushya Battepati, MD1, Justin Bejcek, MS2, Lancaster Weld, DO1, Alexis Bejcek, MD1, James T. Sing, DO1
1Baylor Scott & White Medical Center, Temple, TX; 2Edward Via College of Osteopathic Medicine, Shreveport, LA

Introduction: Malakoplakia is a rare inflammatory disease that can affect any organ system. It is characterized by impaired histiocytes, resulting in incomplete digestion of phagocytized bacteria. The gastrointestinal (GI) tract is the second most common site. Malakoplakia is seen in the setting of immunocompromised states, including being on steroid therapy, chemotherapy and associated with malignancy, post organ transplant, or inflammatory bowel disease. Michaelis-Gutmann (MG) bodies are pathognomonic histological findings of malakoplakia. We present a rare case of colonic malakoplakia that had multiple severe manifestations, mimicking malignancy, and inflammatory bowel disease, in the setting of systemic lupus erythematous (SLE).  

Case Description/

Methods:

This is a 68-year-old female with history of SLE, complicated by esophageal dysmotility (currently on Plaquenil, off Immunosuppression since 11/2024), CMV colitis (treated with two rounds of Valcyte), who was admitted to our hospital from 4/9-4/20 for acute blood loss anemia. The patient was found to have malakoplakia in her colon in 2022, and has been treated 



conservatively. She has had several colonoscopies with biopsies that have confirmed 



malakoplakia. Her clinical course has been complicated by recurrent lower gastrointestinal 



bleeding. Since 3/2025, she had been in frequent contact with her Gastroenterologist about 



ongoing severe abdominal pain and weight loss. CT scan of the abdomen/pelvis showed a right 



mid abdominal mass with pelvic lymphadenopathy, which showed florid mass like 



malakoplakia. The patient has been evaluated by multiple specialist's outpatient including Infectious Diseases, Allergy/Immunology, Rheumatology as well as Hematology/Oncology. During her admission, she was seen by ID who recommended starting a 6-month course of ciprofloxacin. She was evaluated by Rheumatology who recommended to avoid re-initiating immunosuppression. Colorectal surgery did not recommend surgical treatment at this time. 


Discussion: The literature reports cases of GI malakoplakia causing severe symptoms such as gastric outlet obstruction, hemorrhage, and colonic strictures. Treatment for malakoplakia is very dependent on the patient’s symptoms and presentation, rather than guideline based, given the rarity of the disease. This makes it complicated in our patients’ case to find a definitive cure. We hope that this case gives perspective on the complexity of the disease, and the importance of a multi-disciplinary approach, early on in the clinical course.   

Disclosures:
Dhanushya Battepati indicated no relevant financial relationships.
Justin Bejcek indicated no relevant financial relationships.
Lancaster Weld indicated no relevant financial relationships.
Alexis Bejcek indicated no relevant financial relationships.
James Sing indicated no relevant financial relationships.

Dhanushya Battepati, MD1, Justin Bejcek, MS2, Lancaster Weld, DO1, Alexis Bejcek, MD1, James T. Sing, DO1. P4605 - A Rare Case of "Malignant” Gastrointestinal Malakoplakia in the Setting of Systemic Lupus Erythematous, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.