title: A de novo monoclonal immunoglobulin deposition disease in a kidney transplant recipient: a case report.
abstract: BACKGROUND
  Myeloma following kidney transplantation is a rare entity. It can be divided into two groups: relapse of a previous myeloma and de novo myeloma. Some of these myelomas can be complicated by a monoclonal immunoglobulin deposition disease, which is even less common. Less than ten cases of monoclonal immunoglobulin deposition disease after renal graft have been reported in the literature. The treatment of these patients is not well codified.
  
  
  METHODS
  We report the case of a 43-year-old white European man who received a renal transplant for a nephropathy of unknown etiology and developed a nephrotic syndrome with kidney failure at 2-years follow-up. We diagnosed a de novo monoclonal immunoglobulin deposition disease associated with a kappa light chain multiple myeloma, which is a very uncommon presentation for this disease. Three risk factors were identified in this patient: Epstein-Barr virus reactivation with cytomegalovirus co-infection; intensified immunosuppressive therapy during two previous rejection episodes; and human leukocyte antigen-B mismatches. Chemotherapy treatment and decrease in the immunosuppressive therapy were followed by remission and slight improvement of renal function. A relapse occurred 8 months later and his renal function worsened rapidly requiring hemodialysis. He died from septic shock 4 years after the diagnosis of monoclonal immunoglobulin deposition disease.
  
  
  CONCLUSIONS
  This rare case of post-transplant lymphoproliferative disorder with an uncommon presentation illustrates the fact that treatment in such a situation is very difficult to manage because of a small number of patients reported and a lack of information on this disease. There are no guidelines, especially concerning the immunosuppressive therapy management.
authors.affiliation: CHU Nancy-Brabois - Service de Néphrologie, Nancy, France. benjamin.savenkoff@orange.fr.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Savenkoff
authors.forename: Perrine
authors.initials: P
authors.lastname: Aubertin
authors.forename: Marc
authors.initials: M
authors.lastname: Ladriere
authors.forename: Cyril
authors.initials: C
authors.lastname: Hulin
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Champigneulle
authors.forename: Luc
authors.initials: L
authors.lastname: Frimat
mesh_terms: D000328:Adult; D060085:Coinfection; D003586:Cytomegalovirus Infections / Q000150:complications / Q000276:immunology*; D020031:Epstein-Barr Virus Infections / Q000150:complications / Q000276:immunology*; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D016867:Immunocompromised Host; D007147:Immunoglobulin Light Chains / Q000276:immunology; D007150:Immunohistochemistry; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000473:pathology*; D007674:Kidney Diseases / Q000150:complications / Q000276:immunology* / Q000473:pathology; D016030:Kidney Transplantation; D008297:Male; D009101:Multiple Myeloma / Q000150:complications / Q000276:immunology* / Q000473:pathology; D009404:Nephrotic Syndrome / Q000150:complications / Q000276:immunology* / Q000473:pathology
chemical_list: D007147:Immunoglobulin Light Chains; D007166:Immunosuppressive Agents