茲報告一66歲老年女性，過去患有糖尿病、高血壓，以嚴重大腸桿菌尿呫敗血症表現。腎蕷超音波及腹部電腦斷層發現右腎腫大，併有一低密度腫瘤于右腎下部。雖經過了抗生素(Rocephine+Amikacin)長期治療，該病患仍高燒不退。在右腎腫瘤合併尿路鍶染的診斷下，遂實行右腎全切除術。病人術後恢復良好。病理診斷為腎實質軟化斑痕，其診斷特徵仍fMIchailis-Gutmann body。軟化斑痕乃一罕見之發炎病患，最常發生于泌尿道，常合併有桿菌感頲。最初是在1902年由一病理學家診斷出六，然而在泌尿界卻很少受到注意。其確實原因至今仍有爭議，但似乎與巨噬細胞內吞食細菌的轉機發生缺陷有關。萬實質軟化斑痕在過去造成相常高的致病率和致死率，特別是在雙側腎疾的病例，因為期診斷通常是在手術引流或切除腎臟後才由病理學診斷出來。近年來，陸續有報告使用細胞內穿透力的抗生素如trimethoprim，ciprofloxacin或chloramphenicol，可獲致最好的結果。此病例若能先行腎穿刺診斷，並給予正確的競生素治療，也許可免除腎切除。

We report a 66-year-old female patient, with diabetes mellitus presenting with E. Coli urosepsis. Abdominal computerized tomography revealed an enlarged right kidney with a lower pole tumor of hypodensity. Despite seemingly appropriate, antimicrobial treatment with Ro-cephine plus Amikacin didn’t work and the patient continued to have a daily fever. So, radical nephrectomy was undertaken under the impressionof a renal tumor with infection. The patient had an uneventful recovery. A pathologist defined the diagnosis of renal parenchymal malak-oplakia, characterized by Michaelis-Gutmann bodies. Malakoplakia is a rare inflammatory disorder seen most often in the urinary tract. Although first recognized by pathologists in 1902, it has received little attention from the urological pro-fession. The specific cause is uncertain but may include altered immune response, dysfunction of histiocytes and undigested bacterial fragments as the nidus for mineralizing Michaelis-Gutmann bodies. Renal parenchymal malakoplakia has traditionally been associated with high morbidity and mortality, because it is usually diagnosed pathologically after surgical intervention. More recently, treatment with antibiotics such as trimethoprim, ciprofloxacin, and chlo-ramphenicol,which are capable of intracellular penetration, has yielded a better outcome than other therapies which had been documented. Nephrectomy might have been avoided if renal bi-opsy had been performed to confirm malakoplakia, and proper antibiotics had been used. (J Urol R.O.C., 9:45-49,1998)