Korean J Fam Med. 2011;32:367-372 http://dx.doi.org/10.4082/kjfm.2011.32.6.367 Malakoplakia of the Kidney Extending to the Descending Colon in a Patient with Secondary Adrenal Insufficiency: A Case Report Case Report Soo Jin Jung, Hee Cheol Kang*, Jun Jeong Choi1 Department of Family Medicine, Yonsei University College of Medicine, Seoul, 1Department of Pathology, Yonsei University Wonju College of Medicine, Wonju, Korea Malakoplakia is an uncommon but distinctive type of chronic granulomatous inﬂammation that occurs most commonly in the genitourinary tract, especially the urinary bladder. Most patients have associated conditions characterized by some degree of immunosuppression, as seen in solid-organ transplants, autoimmune diseases requiring steroid use, chemotherapy, chronic systemic diseases, alcohol abuse and poorly controlled diabetes. We report an unusual case of the renal malakoplakia that involved the perirenal space, extending to the descending colon in a 65-year-old Korean woman with secondary adrenal insufﬁciency and diabetes mellitus. Keywords: Malakoplakia; Adrenal Insufﬁciency; Diabetes Mellitus; Korea INTRODUCTION Malakoplakia is a rare chronic inflammatory disease that of the kidney is difficult to diagnose because of its rarity and occurs most commonly in the genitourinary tract, especially varying histological pictures.2) To our knowledge, there have the urinary bladder. Most patients have associated conditions been no case reports of malakoplakia of the kidney in a secondary characterized by some degree of immunosuppression, as seen in adrenal insufficiency from Korea. Here, we report an unusual case solid-organ transplants, autoimmune diseases requiring steroid of renal malakoplakia involving the perirenal space and extending use, chemotherapy, chronic systemic diseases, alcohol abuse to the descending colon in a 65-year-old Korean woman with and poorly controlled diabetes.1) Despite some characteristic histological features including the presence of large histiocytes with clusters of Michaelis-Gutmann (MG) bodies, malakoplakia Received: June 9, 2011, Accepted: September 8, 2011 *Corresponding Author: Hee Cheol Kang Tel: 82-2-2228-2332, Fax: 82-2 362-2473 E-mail: kanghc@yuhs.ac Korean Journal of Family Medicine Copyright © 2011 The Korean Academy of Family Medicine This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Korean J Fam Med secondary adrenal insufficiency and diabetes mellitus. CASE REPORT In March 2010, a 65-year-old woman was transferred from the National Police Hospital (NPH) to our facility, Shinchon Severance Hospital (Seoul, Korea) via the emergency room (ER), presenting with a decreased level of consciousness. According to her medical history, she had hypertension, diabetes mellitus for 10 years, recurrent cystitis, and degenerative arthritis. She Vol. 32, No. 6 Sep 2011 | 367