title: Membranous nephropathy and lupus-like syndrome after hematopoietic cell transplantation: a case report.
abstract: BACKGROUND
  The kidney is increasingly recognised as a target organ of chronic graft-versus-host disease after hematopoietic cell transplantation in the context of the development of the nephrotic syndrome. Chronic graft-versus-host disease is associated with autoimmune phenomena similar, but not identical, to those observed in various rheumatologic disorders, implicating autoimmunity as an important component of the disease.
  
  
  METHODS
  We report the case of a 57-year-old Caucasian man who developed the nephrotic syndrome due to membranous nephropathy in association with recurrent chronic graft-versus-host disease, along with a lupus-like syndrome manifested with pancytopenia, hair loss, positive anti-DNA antibodies and sub-epithelial and mesangial immune deposits. To the best of our knowledge, this is the first case reported in the literature. The nephrotic syndrome subsided soon after he was treated with a short course of cyclosporin with steroids. Unfortunately he died seven months later due to a relapse of leukemia.
  
  
  CONCLUSIONS
  Our case report confirms the notion that chronic graft-versus-host disease is characterized by the appearance of autoimmune phenomena similar, but not identical, to those seen in autoimmune diseases. The decision for more immunosuppression has to be weighed against the need for preservation of the graft versus leukemia phenomenon.
authors.affiliation: Nephrology Department, Heraklion University Hospital, PO Box 1352, 71110 Heraklion, Crete, Greece. kstylianu@gmail.com.
authors.forename: Kostas
authors.initials: K
authors.lastname: Stylianou
authors.forename: Stavros
authors.initials: S
authors.lastname: Stratakis
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Mavroeidi
authors.forename: Ioannis
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authors.lastname: Petrakis
authors.forename: Dimitris
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authors.lastname: Xydakis
authors.forename: Eleftheria
authors.initials: E
authors.lastname: Vardaki
authors.forename: Spyros
authors.initials: S
authors.lastname: Stratigis
authors.forename: Kostas
authors.initials: K
authors.lastname: Perakis
authors.forename: Theodora
authors.initials: T
authors.lastname: Katsarou
authors.forename: Peggy
authors.initials: P
authors.lastname: Kanellou
authors.forename: Irene
authors.initials: I
authors.lastname: Xylouri
authors.forename: Constantina
authors.initials: C
authors.lastname: Petraki
authors.forename: Michael
authors.initials: M
authors.lastname: Alexandrakis
authors.forename: Eugene
authors.initials: E
authors.lastname: Daphnis