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New Onset Systemic Lupus Erythematous After Kidney Transplant: Case Report
Alexandra Esteves1, Andreia Henriques1, Beatriz Fernandes1
1Nephrology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
Transplantation Proceedings
|August 14, 2025
Summary
Diagnosing new autoimmune diseases in kidney transplant recipients is difficult. This case report details a rare instance of de novo Systemic Lupus Erythematosus (SLE) developing nine years post-transplant, notably without kidney involvement.
Area of Science:
- Nephrology
- Immunology
- Rheumatology
Background:
- Diagnosing new autoimmune diseases in kidney transplant patients presents significant challenges.
- New onset Systemic Lupus Erythematosus (SLE) following kidney transplantation is exceptionally rare, with limited reported cases.
Purpose of the Study:
- To report a rare case of de novo SLE in a kidney transplant recipient.
- To highlight the diagnostic challenges and unique presentation of post-transplant SLE without renal involvement.
Main Methods:
- A case study of a kidney transplant patient presenting with non-specific inflammatory symptoms nine years post-transplant.
- Diagnostic workup included immunological testing (ANA, anti-dsDNA antibodies, beta-2 microglobulin) and assessment of renal function and urinary sediment.
- Diagnosis was confirmed using the EULAR/ACR 2019 criteria for SLE.
Main Results:
- The patient presented with fever, diarrhea, migratory polyarthralgia, myalgias, cramps, and rash.
- Immunological tests were positive for ANA, anti-dsDNA antibodies, and elevated beta-2 microglobulin.
- Crucially, the patient showed no signs of renal involvement, maintaining stable kidney function and normal urinary sediment.
- Treatment with corticosteroids and belimumab resulted in partial clinical and serological improvement over ten months.
Conclusions:
- This case underscores a rare presentation of de novo SLE post-kidney transplant, characterized by the absence of renal involvement.
- A high index of suspicion is essential for transplant recipients exhibiting non-specific inflammatory symptoms suggestive of autoimmune disease.
- Early diagnosis and appropriate management, including novel therapies like belimumab, can lead to improved outcomes.
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