Patients with malakoplakia usually present with fever, flank and/or loin pain, and a history of E. coli urinary tract infection. Malakoplakia may occur at any age, but most commonly presents in the fifth decade of life with a predilection for women over men (4:1). Patients may be immunosuppressed, with underlying conditions such as AIDS, diabetes, alcohol abuse, or another immunocompromised state. Bilateral kidney involvement occurs in less than half of cases and usually presents with acute kidney injury.