ArticleFrontiers in immunology2026
Graves' disease following immunosuppression withdrawal and SARS-CoV-2 infection in a failed kidney allograft recipient: a case report on immune reconstitution.
Article in Frontiers in immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Immune recovery after withdrawal of long-term immunosuppression may unmask autoimmune disease, but thyroid autoimmunity in patients with failed kidney allografts remains poorly characterized. We report a 29-year-old man with kidney allograft failure who developed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection after discontinuation of maintenance immunosuppression and subsequently presented with weight loss, tremor, tachycardia, diffuse goiter, and overt thyrotoxicosis. Positive thyrotropin receptor antibodies (TRAb) and diffusely increased radionuclide uptake supported a diagnosis of Graves' disease rather than destructive thyroiditis. His symptoms and thyroid function improved following treatment with methimazole, propranolol, glucocorticoids, and supportive treatment. Extracorporeal blood-purification therapies were used in the setting of persistent tachycardia, dialysis-related blood pressure fluctuations, and systemic inflammation, although their independent contribution could not be determined. Persistently elevated TRAb levels despite low peripheral B-cell counts suggested that circulating B-cell numbers did not reliably reflect humoral autoimmune activity. This case highlights a possible immune reconstitution-associated form of thyroid autoimmunity after immunosuppression withdrawal and emphasizes early recognition and thyroid evaluation following new inflammatory triggers.
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