Prostatic malakoplakia associated with severe chronic active prostatitis

A 70-year-old black male presented with a 2-month history of obstructive lower urinary tract symptoms. He had no current or previous proven history of urinary tract infections and was not on any antibiotics, steroids or immunosuppressive drugs. A tender, firm and non-nodular prostate was noted on digital rectal examination and his prostate-specific antigen level was 32.4 ug/L. Histopathological analysis following transrectal ultrasound-guided prostate biopsy showed an unusual finding, malakoplakia associated with severe chronic active prostatitis. Only a limited number of cases of prostatic malakoplakia have ever been reported in the literature. We present the first ever case of malakoplakia without any evidence of urinary tract infection associated with severe chronic active prostatitis in a black African male. Level of evidence: Level 5.