Journal of Medical Case Reports (Sep 2010)

Membranous nephropathy and lupus-like syndrome after hematopoietic cell transplantation: a case report

  • Stylianou Kostas,
  • Stratakis Stavros,
  • Mavroeidi Vasiliki,
  • Petrakis Ioannis,
  • Xydakis Dimitris,
  • Vardaki Eleftheria,
  • Stratigis Spyros,
  • Perakis Kostas,
  • Katsarou Theodora,
  • Kanellou Peggy,
  • Xylouri Irene,
  • Petraki Constantina,
  • Alexandrakis Michael,
  • Daphnis Eugene

DOI
https://doi.org/10.1186/1752-1947-4-303
Journal volume & issue
Vol. 4, no. 1
p. 303

Abstract

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Abstract Introduction The kidney is increasingly recognised as a target organ of chronic graft-versus-host disease after hematopoietic cell transplantation in the context of the development of the nephrotic syndrome. Chronic graft-versus-host disease is associated with autoimmune phenomena similar, but not identical, to those observed in various rheumatologic disorders, implicating autoimmunity as an important component of the disease. Case presentation We report the case of a 57-year-old Caucasian man who developed the nephrotic syndrome due to membranous nephropathy in association with recurrent chronic graft-versus-host disease, along with a lupus-like syndrome manifested with pancytopenia, hair loss, positive anti-DNA antibodies and sub-epithelial and mesangial immune deposits. To the best of our knowledge, this is the first case reported in the literature. The nephrotic syndrome subsided soon after he was treated with a short course of cyclosporin with steroids. Unfortunately he died seven months later due to a relapse of leukemia. Conclusions Our case report confirms the notion that chronic graft-versus-host disease is characterized by the appearance of autoimmune phenomena similar, but not identical, to those seen in autoimmune diseases. The decision for more immunosuppression has to be weighed against the need for preservation of the graft versus leukemia phenomenon.