Pontes L T, Camilo D T, De Bortoli M R, Santos R S S, Luchi W M
Nephrology Service, Cassiano Antonio Moraes University Hospital, Federal University of Espírito Santo (HUCAM-UFES), Vitória (ES), Brazil.
Lupus. 2018 Nov;27(13):2166-2169. doi: 10.1177/0961203318800571. Epub 2018 Sep 19.
We report an original case of a 27-year-old transgender woman who developed lupus nephritis after male-to-female sex reassignment surgery. The patient had been taking hormones to induce feminization since the age of 18. She was admitted with malar "butterfly" rash, anasarca and hypertension, associated with an increase in serum creatinine (1.7 mg/dl). Renal involvement was characterized by nephritic and nephrotic syndrome. Autoantibody tests were positive for antinuclear antibodies and anti-double-stranded DNA, and complement levels were markedly reduced. Renal biopsy demonstrated diffuse proliferative glomerulonephritis and granular immune complexes deposits with a "full-house" pattern at the immunofluorescence level. The induction treatment was realized with corticosteroid and cyclophosphamide and maintenance immunosuppression phase with mycophenolate, obtaining complete remission. We speculated that lupus nephritis was induced by estrogens and antiandrogen therapy and gonadectomy. In the present case, we discuss the role of sex hormones in systemic lupus erythematosus onset and review the cases linked to transgender patients.
我们报告了一例27岁的变性女性的原始病例，该患者在男性变女性性别重置手术后发生了狼疮性肾炎。该患者自18岁起就一直在服用激素以诱导女性化。她因出现颊部“蝶形”皮疹、全身性水肿和高血压入院，同时伴有血清肌酐升高（1.7mg/dl）。肾脏受累表现为肾炎和肾病综合征。自身抗体检测抗核抗体和抗双链DNA呈阳性，补体水平显著降低。肾活检显示弥漫性增殖性肾小球肾炎，免疫荧光水平呈颗粒状免疫复合物沉积，呈“满堂亮”模式。诱导治疗采用皮质类固醇和环磷酰胺，维持免疫抑制阶段采用霉酚酸酯，最终实现完全缓解。我们推测狼疮性肾炎是由雌激素、抗雄激素治疗和性腺切除术诱发的。在本病例中，我们讨论了性激素在系统性红斑狼疮发病中的作用，并回顾了与变性患者相关的病例。
