Cutaneous Vasculitis After Renal Transplantation: A Case Report

• Published in: Transplantation proceedings 2012-12, Vol.44 (10), p.3048-3050
• Main Authors: Rau, S, Wollenberg, A, Weiss, M, Fischereder, M, Schönermarck, U
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Biomarkers - analysis; Biopsy; Diagnosis, Differential; Drug Therapy, Combination; Exanthema - diagnosis; Exanthema - drug therapy; Exanthema - immunology; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Glomerulonephritis, IGA - diagnosis; Glomerulonephritis, IGA - immunology; Glomerulonephritis, IGA - surgery; Humans; Immunoglobulin A - analysis; Immunosuppressive Agents - adverse effects; Kidney - drug effects; Kidney - immunology; Kidney - pathology; Kidney Transplantation - adverse effects; Kidney Transplantation - immunology; Male; Medical sciences; Predictive Value of Tests; Purpura, Schoenlein-Henoch - diagnosis; Purpura, Schoenlein-Henoch - drug therapy; Purpura, Schoenlein-Henoch - immunology; Recurrence; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Skin - drug effects; Skin - immunology; Skin - pathology; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Tissue, organ and graft immunology; Treatment Outcome
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2012.04.037

Abstract Background Cutaneous vasculitis is a rare symptom after renal transplantation. With a broad spectrum of differential diagnosis, the new appearance of a skin rash in transplanted patients can be challenging. Case Report We present the case of a 69-year-old man with palpable purpura, skin ulcerations, and diffuse arthralgias. He had a history of cadaveric renal transplantation owing to biopsy-proven isolated immunoglobulin (Ig)A nephropathy and never suffered from any skin manifestation before. Skin biopsy confirmed Henoch–Schoenlein purpura (HSP), which developed under maintenance immunsuppressive therapy with tacrolimus and mycophenolate mofetil. Renal biopsy showed recurrent IgA nephropathy with positive mesangial and capillary IgA staining. Discussion This is the first case to describe a new manifestation of HSP following renal transplantation owing to isolated IgA nephropathy. Here, we summarize the differential diagnosis of cutaneous vasculitis following renal transplantation. Moreover we give a short review of the recurrence of IgA nephropathy and HSP after renal transplantation followed by possible strategies for prevention and therapy of recurrent disease.