Case report: Nephrotic syndrome and portal hypertensive ascites after allogeneic hematopoietic stem cell transplantation: a rare manifestation of chronic graft-versus-host disease

Front Immunol. 2024 Oct 16:15:1464616. doi: 10.3389/fimmu.2024.1464616. eCollection 2024.

Abstract

Chronic graft-versus-host disease (GVHD) is a major complication after allogeneic hematopoietic stem cell transplantation (HSCT). Chronic GVHD may have atypical manifestations affecting non-classical organs. The diagnosis in patients with atypical manifestations of chronic GVHD is particullarly challenging, and there is a lack of knowledge regarding their pathogenesis and treatment. We reported a case who developed post-HSCT nephrotic syndrome and portal hypertensive ascites, which are both rare and atypical manifestations of chronic GVHD. Kidney biopsy revealed membranous nephropathy and renal thrombotic microangiopathy with glomerular immune deposits, suggesting antibody-mediated kidney injury. Treatment with ruxolitinib resulted in remission of both nephrotic syndrome and ascites, suggesting a role of cytokines in the pathogenesis. This case highlighted the awareness of nephrotic syndrome and portal hypertensive ascites as atypical manifestations of chronic GVHD, and the efficacy of ruxolitinib for the two manifestations.

Keywords: ascites; chronic GVHD; membranous nephropathy (MN); ruxolitinib; thrombotic microangiopathy (TMA).

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Ascites* / etiology
  • Biopsy
  • Chronic Disease
  • Graft vs Host Disease* / diagnosis
  • Graft vs Host Disease* / etiology
  • Hematopoietic Stem Cell Transplantation* / adverse effects
  • Humans
  • Hypertension, Portal* / diagnosis
  • Hypertension, Portal* / etiology
  • Male
  • Middle Aged
  • Nephrotic Syndrome* / diagnosis
  • Nephrotic Syndrome* / etiology
  • Nitriles / therapeutic use
  • Pyrazoles / therapeutic use
  • Pyrimidines / therapeutic use
  • Transplantation, Homologous / adverse effects

Substances

  • ruxolitinib
  • Pyrazoles
  • Pyrimidines
  • Nitriles

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the National High Level Hospital Clinical Research Funding (2022-PUMCH-B-020 to YQ) and the National Natural Sciences Foundation of China (Grant 81970621 to YQ).