{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T18:37:13Z","timestamp":1770230233713,"version":"3.49.0"},"reference-count":13,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T00:00:00Z","timestamp":1770163200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>\n                    Post-transplant anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) recurrence on the allograft is rare and, to our knowledge, has never been described in the situation of a previous double-positive vasculitis with both ANCA and anti-glomerular basement membrane (GBM) antibodies. We report an unusual case of anti-myeloperoxydase (MPO) antibody-associated vasculitis recurrence occurring 14 years after kidney transplantation following a double-positive anti-GBM and anti-MPO glomerulonephritis. The transplant induction regimen consisted of anti-thymocyte globulin, and initial maintenance therapy associated tacrolimus, mycophenolate mofetil, and corticosteroids. Mycophenolate mofetil was discontinued 4 months after transplantation due to persistent leukopenia, and tacrolimus was maintained along with corticosteroids. At 14 years post-transplantation, the patient presented with diffuse alveolar hemorrhage, acute kidney injury stage 1 of Kidney Disease Improving Global Outcomes, proteinuria, microhematuria, serous otitis media and anti-MPO antibodies resurgence, without detectable anti-GBM antibodies. A kidney allograft biopsy was performed and showed rare active crescents with severe chronic injuries. This pulmonary and renal involvement was attributed to an anti-MPO antibody-associated vasculitis recurrence. The induction treatment of the relapse consisted of methylprednisolone at 5 mg\/kg and rituximab at 375 mg\/m\n                    <jats:sup>2<\/jats:sup>\n                    per week for 4 weeks. Renal function remained stable, urinary protein to creatinine ratio decreased from 0.9 g\/g to 0.3 and 0.2 g\/g at 6 and 12 months, respectively. Microhematuria resolved at 6 months and remained absent subsequently. Maintenance treatment was continued with rituximab every 6 months. According to the literature, post-transplant isolated AAV recurrence on the allograft remains exceptional, ranging between 0.003 and 0.076 per patient per year. To our knowledge, there are no reported cases of post-transplant anti-MPO-associated vasculitis recurrence in a patient with former anti-MPO and anti-GBM antibody-associated vasculitis. This case underlines the fact that AAV can recur late after transplantation in previously double-positive vasculitis patients. Thus, close monitoring of clinical and biological signs of recurrence is necessary in these patients. Because the pathophysiology of this atypical entity remains unclear, further trials are still necessary to highlight the underlying mechanisms of this particular auto-immune association and, more specifically, of isolated post-transplant AAV recurrence in double-positive patients to improve prevention and to elaborate more efficient immunosuppressive strategies.\n                  <\/jats:p>","DOI":"10.3389\/fimmu.2026.1723903","type":"journal-article","created":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T06:37:21Z","timestamp":1770187041000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Late post-transplant recurrence of an anti-myeloperoxydase antibody-associated vasculitis in a former double-positive patient: a case report"],"prefix":"10.3389","volume":"17","author":[{"given":"Nessma","family":"Chenaf-Benabdelmoumene","sequence":"first","affiliation":[{"name":"Universit\u00e9 Marie et Louis Pasteur, Centre Hospitalier Universitaire (CHU) de Besan\u00e7on, Service de N\u00e9phrologie-Dialyse-Transplantation","place":["Besan\u00e7on, France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melchior","family":"Chabannes","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Marie et Louis Pasteur, Centre Hospitalier Universitaire (CHU) de Besan\u00e7on, Service de N\u00e9phrologie-Dialyse-Transplantation","place":["Besan\u00e7on, France"]},{"name":"Universit\u00e9 Marie et Louis Pasteur, Etablissement Fran\u00e7ais du Sang (EFS), Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale (INSERM), RIGHT (UMR 1098)","place":["Besan\u00e7on, France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Didier","family":"Ducloux","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Marie et Louis Pasteur, Centre Hospitalier Universitaire (CHU) de Besan\u00e7on, Service de N\u00e9phrologie-Dialyse-Transplantation","place":["Besan\u00e7on, France"]},{"name":"Universit\u00e9 Marie et Louis Pasteur, Etablissement Fran\u00e7ais du Sang (EFS), Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale (INSERM), RIGHT (UMR 1098)","place":["Besan\u00e7on, France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamal","family":"Bamoulid","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Marie et Louis Pasteur, Centre Hospitalier Universitaire (CHU) de Besan\u00e7on, Service de N\u00e9phrologie-Dialyse-Transplantation","place":["Besan\u00e7on, France"]},{"name":"Universit\u00e9 Marie et Louis Pasteur, Etablissement Fran\u00e7ais du Sang (EFS), Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale (INSERM), RIGHT (UMR 1098)","place":["Besan\u00e7on, France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Crepin","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Marie et Louis Pasteur, Centre Hospitalier Universitaire (CHU) de Besan\u00e7on, Service de N\u00e9phrologie-Dialyse-Transplantation","place":["Besan\u00e7on, France"]},{"name":"Universit\u00e9 Marie et Louis Pasteur, Etablissement Fran\u00e7ais du Sang (EFS), Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale (INSERM), RIGHT (UMR 1098)","place":["Besan\u00e7on, France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"St\u00e9phane","family":"Lang","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Marie et Louis Pasteur, Centre Hospitalier Universitaire (CHU) de Besan\u00e7on, Service de N\u00e9phrologie-Dialyse-Transplantation","place":["Besan\u00e7on, France"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2017.03.014","article-title":"Patients double-seropositive for ANCA and anti-GBM antibodies have varied renal survival, frequency of relapse, and outcomes compared to single-seropositive patients","volume":"92","author":"McAdoo","year":"2017","journal-title":"Kidney Int"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2021.102885","article-title":"ANCA and anti-glomerular basement membrane double-positive patients: a systematic review of the literature","volume":"20","author":"Philip","year":"2021","journal-title":"Autoimmun Rev"},{"key":"B3","article-title":"Maladie des anticorps anti-membrane basale glom\u00e9rulaire: G\u00e9n\u00e9ralit\u00e9s","author":"Cartery","year":"2020","journal-title":"Fai2R Off website"},{"key":"B4","article-title":"Sequential development of systemic vasculitis with anti-neutrophil cytoplasmic antibodies complicating anti-glomerular basement membrane disease","volume":"32","author":"O\u2019Donoghue","year":"1989","journal-title":"Clin Nephrol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1038\/ki.1990.72","article-title":"Autoantibodies to GBM and neutrophil cytoplasm in rapidly progressive glomerulonephritis","volume":"37","author":"Jayne","year":"1990","journal-title":"Kidney Int"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2023.10.008","article-title":"KDIGO 2024 clinical practice guideline for the management of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis","volume":"105","author":"Floege","year":"2024","journal-title":"Kidney Int"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.3390\/medicina57121325","article-title":"Anti-neutrophil cytoplasmic antibody-associated vasculitis in kidney transplantation","volume":"57","author":"Binda","year":"2021","journal-title":"Medicina"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e318264fbef","article-title":"Outcome of renal transplantation in patients with both ANCA and anti-GBM antibodies","volume":"94","author":"Raman","year":"2012","journal-title":"Transplantation"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2010050477","article-title":"Histopathologic classification of ANCA-associated glomerulonephritis","volume":"21","author":"Berden","year":"2010","journal-title":"J Am Soc Nephrology"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfac016","article-title":"Early and late ANCA vasculitis relapses after kidney transplantation may have different presentations","volume":"15","author":"Masset","year":"2022","journal-title":"Clin Kidney J"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/858027","article-title":"The influence and role of microbial factors in autoimmune kidney diseases: a systematic review","volume":"2015","author":"Kronbichler","year":"2015","journal-title":"J Immunol Res"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2017-212878","article-title":"Comparison of individually tailored versus fixed-schedule rituximab regimen to maintain ANCA-associated vasculitis remission: results of a multicentre, randomised controlled, phase III trial (MAINRITSAN2)","volume":"77","author":"Charles","year":"2018","journal-title":"Ann Rheumatic Diseases"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.1658","article-title":"Mycophenolate mofetil vs azathioprine for remission maintenance in antineutrophil cytoplasmic antibody-associated vasculitis: a randomized controlled trial","volume":"304","author":"Hiemstra","year":"2010","journal-title":"J Am Med Assoc"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1723903\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T06:37:22Z","timestamp":1770187042000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1723903\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,4]]},"references-count":13,"alternative-id":["10.3389\/fimmu.2026.1723903"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2026.1723903","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,4]]},"article-number":"1723903"}}