New Onset Systemic Lupus Erythematous After Kidney Transplant: Case Report

The diagnosis of new onset autoimmune diseases in kidney transplant patients is challenging with new onset SLE after kidney transplant being a rare condition, with very few cases reported. We describe a case of a kidney transplant patient who, after 9 years presented with intermittent fever and diarrhea, inflammatory migratory polyarthralgia, myalgias, cramps and an erythematous rash in the cleavage area. Immunological testing revealed positive antinuclear antibodies (ANA 1:640), anti-double-stranded DNA antibodies (53.2 IU/mL), and elevated beta-2 microglobulin (105.59 U/mL), leading to the diagnosis of de novo SLE according to EULAR/ACR 2019 criteria. Notably, the patient exhibited no evidence of renal involvement from the onset, with stable kidney function and normal urinary sediment throughout follow-up. Ten months after undergoing treatment with corticosteroids and belimumab there was partial clinical and serological improvement. This case highlights a rare presentation of post-transplant SLE without renal involvement, reinforcing the need for a high index of suspicion in transplant recipients presenting with non-specific inflammatory symptoms.