Drug-induced lupus as a cause of relapsing inflammatory disease after renal transplantation.
We discuss the case of an 18-year-old-boy presenting with relapsing fever, arthralgia, myalgia and renal failure, 7 yr after renal transplantation. A thorough diagnostic work-up for infectious and inflammatory diseases revealed a mastoiditis and atypical mycobacteria, but symptoms persisted after treatment. Persistent antinuclear antibodies in combination with cardiolipin and myeloperoxidase antibodies, despite negative dsDNA antibodies, suggested a drug induced lupus-like syndrome. Six months after withdrawal of dihydralazine, all symptoms had disappeared. Drug-induced lupus should be considered as an important differential diagnosis in transplanted patients with recurrent inflammatory disease in conjunction with lupus-like symptoms and negative dsDNA antibodies. It may prevent a potentially hazardous reduction of immunosuppression in persistent inflammation.
Pape
Lars
L
Department of Pediatric Nephrology and Metabolic Diseases, Medical School of Hannover, D-30623, Germany. larspape@t-online.de
Strehlau
Juergen
J
Latta
Kay
K
Ehrich
Jochen Hh
JH
Offner
Gisela
G
D000293:Adolescent; D000959:Antihypertensive Agents / Q000009:adverse effects*; D003937:Diagnosis, Differential; D004078:Dihydralazine / Q000009:adverse effects*; D006801:Humans; D016030:Kidney Transplantation; D008180:Lupus Erythematosus, Systemic / Q000139:chemically induced* / Q000175:diagnosis; D008297:Male; D012008:Recurrence; D013577:Syndrome
D000959:Antihypertensive Agents; D004078:Dihydralazine