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.