Development of Graves' disease in a patient under immunosuppressive therapy after liver transplantation

Susceptibility to Graves' disease (GD) is determined by multiple environmental and genetic factors, which are not fully understood. Because of the autoimmune etiology of the disease, recent reports describing the development of GD during long-term immunosuppressive treatment seem quite surprising. We report a second case of GD in a 17-yr old patient, treated with cyclosporin A and prednisone, after liver transplantation. The development of GD despite adequate immunosuppressive therapy may suggest that this patient had a genetic predisposition to autoimmunity and severe immunoregulatory defects. We analyzed the HLA-DRB1 alleles and cytotoxic T lymphocyte associated antigen-4 (CTLA-4) gene polymorphism (A/G) at position 49 in exon 1. The patient had the HLA-DRB1*03 allele which is known to confer susceptibility to GD. Further studies are necessary to identify genes that may predispose patients specifically to GD during immunosuppressive therapies.