| Chronic Graft-versus-host disease presenting as a membranous nephropathy in a patient with acute lymphoblastic leukemia |
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Ji Ye Jung, Sul Hee Yoon, Doh Yu Hwang, June Won Cheong, Jin Seok Kim, Hyun Joo Jung, Yoo Hong Min |
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| 증례 : 급성림프구성백혈병 환자에서 막성 콩팥병증으로 나타난 만성 이식편대 숙주병 1예 |
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정지예.윤설희.황도유.정준원.김진석.정현주.민유홍, Sul Hee Yoon, Doh Yu Hwang, June Won Cheong, Jin Seok Kim, Hyun Joo Jung, Yoo Hong Min |
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| Abstract |
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Membranous nephropathy has been described as one of the clinical manifestations of chronic graft-versus-host disease (GVHD), but very few cases have been reported. Here, we report the case of a 19-year-old man with nephrotic syndrome that developed after conventional HLA-matched allogeneic hematopoietic stem cell transplantation (HSCT). The patient showed grade III acute GVHD affecting the skin, liver, and colon, which was controlled via steroid and infliximab therapy. Twenty-one months after HSCT, the patient was admitted to our emergency department with general weakness, generalized edema, nephrotic-range proteinuria (40.7 g/24h), hypoalbuminemia (1.0 g/dL), and hypercholesterolemia (308 mg/dL). Renal biopsy was consistent with membranous nephropathy. After high-dose steroid monotherapy for 6 weeks, proteinuria decreased to 6.9 g/24h and performance status was improved. In this case, nephrotic syndrome was the only manifestation of chronic GVHD, and membranous nephropathy may have occurred due to immune complex formation with local host antigens, without direct donor T-cell infiltration into the kidney. (Korean J Med 75:S801-S805, 2008) |
| Key Words:
Allogeneic hematopoietic stem cell transplantation; Graft-versus-host disease; Membranous nephropathy |
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