Promising outcomes of kidney transplantation following hematopoeitic stem cell transplantation has been reported. Data from some centers have demonstrated stable graft function without long term immunosuppression. We present our experience with the first successful case in Malaysia. This is a 21-year-old man who had acute myeloid leukemia, received stem cell transplant from his younger brother 8 years prior, underwent kidney transplantation from the same donor, and had an excellent 1-year graft function post-transplant. As the post-transplant genetic analysis revealed full chimerism, his immunosuppression regimen can be tapered to minimal doses safely. The concept of immunotolerance is now widely studied and could potentially be the curative strategy for patients who develop end stage kidney disease after hematopoeitic stem cell transplantation.
Thymoma is associated with a wide spectrum of autoimmune paraneoplastic syndromes, though it is uncommon for multiple paraneoplastic syndromes to be present in a single individual. We report a rare case of an elderly gentleman who was found to have thymoma-associated myasthenia gravis and LGI1-encephalitis with myokymia, who presented with nephrotic syndrome (minimal change glomerulopathy) after thymectomy. The latter two paraneoplastic syndromes had manifested when prednisolone was tapered down to low dose. This case serves to remind neurologists that apart from paraneoplastic neurological manifestations, thymoma may also be associated with renal disease. Nephropathy in myasthenia patients with thymoma should be properly evaluated, as it is treatable with immunotherapy, and it may even occur post-thymectomy.