Malakoplakia mimicking a colonic tumour: imaging findings, non-surgical management and follow up.

Malakoplakia is a rare granulomatous disease that most frequently affects the genitourinary tract. Its presentation in the colon as a mass lesion is exceptional and poses a significant diagnostic challenge as it closely mimics malignancy on imaging. This case report details the CT and MRI findings of descending colonic malakoplakia in a woman in her 60s with diabetes. The diagnosis was confirmed histopathologically by the presence of Michaelis-Gutmann bodies. The patient was successfully treated with fluoroquinolone antibiotics, which led to near-complete radiological and endoscopic resolution of the lesion after 2 years. This case report demonstrates that imaging may raise clinical suspicion of the disease and guide biopsy and follow-up. However, histological diagnosis remains essential before a decision is made regarding non-surgical management.