Auto-immune diseases (AID) were rarely described after renal transplantation (RT). They correspond in the most of cases to the recurrence of the systemic disease causative of initial nephropathy. In addition, de-Novo auto-immune diseases were exceptionally described in these patients maintained on immunosuppressive therapy which is known to be protective against the development of such diseases.
We report the case of a 24-year-old kidney transplant recipient who developed de-Novo SLE treated successfully with intravenous immunoglobulins (IVIG). RT was performed using a kidney of her HLA-identical sister after 1 year of hemodialysis started for ESRD attributed to reflux-nephropathy. Her maintenance immunosuppression included prednisone and azathioprine with an uneventful initial course in the exception of a high blood pressure treated with Amlodipine and Acebutolol. Four years later, she developed fever, arthritis, skin rash, mucosal ulcerations with leucopenia and hemolytic anemia. ANA and ADNA were positive, anti-histone and anti-RNP antibodies were negative. Infectious causes were ruled out and Acebutolol was discontinued. She was switched from azathioprine to MMF and corticosteroids were raised to the dose of 1 mg/kg/day. After a transitory improvement, symptoms relapsed with peri-orbital macular eruption and extensive cutaneous ulcerations and muscle involvement confirmed by electromyography. The diagnosis of dermatopolymyositis associated with SLE was made. Treatment which consisted on Methylprednisolone and IVIG, given monthly, resulted in a substantial improvement of clinical and serological abnormalities. In our knowledge, this is the first reported case of de-Novo SLE diagnosed after RT according to 6 ARA-Criteria without renal involvement. High doses of IVIG resulted in a substantial clinical and serological improvement.