title: Anti-glomerular basement membrane glomerulonephritis with subsequent pulmonary hemorrhage in the course of pulmonary tuberculosis.
abstract: A 66-year-old man with uremia and on hemodialysis was referred to our hospital because of hemoptysis. A chest radiograph showed diffuse infiltration in the right lung field. Laboratory data were remarkable for renal failure accompanied by hematuria and proteinuria. A kidney biopsy revealed diffuse crescentic glomerulonephritis with linear staining of IgG along the glomerular basement membrane (GBM). Circulating IgG anti-GBM antibody was not detected. Because the findings of renal biopsy suggested anti-GBM disease, the patient was treated with plasmapheresis and pulse steroid therapy, which resulted in a rapid resolution of his pulmonary symptoms and chest radiograph abnormalities. However, sputum culture submitted on admission yielded Mycobacterium tuberculosis 3 weeks later. Therefore, immunosuppressive agents were discontinued and antituberculous agents were administrated. No relapse of pulmonary hemorrhage occurred during the next 1-year period of follow-up, but the patient did not regain renal function and remained on hemodialysis.
authors.affiliation: Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Yao-Peng
authors.initials: YP
authors.lastname: Hsieh
authors.forename: Yao-Ko
authors.initials: YK
authors.lastname: Wen
mesh_terms: D000368:Aged; D019867:Anti-Glomerular Basement Membrane Disease / Q000150:complications* / Q000175:diagnosis; D000888:Antibodies, Anti-Idiotypic / Q000032:analysis; D001323:Autoantibodies / Q000032:analysis; D001706:Biopsy; D003937:Diagnosis, Differential; D006469:Hemoptysis / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007678:Kidney Glomerulus / Q000276:immunology / Q000473:pathology; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D013902:Radiography, Thoracic; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000175:diagnosis / Q000276:immunology
chemical_list: D000888:Antibodies, Anti-Idiotypic; D001323:Autoantibodies; C051951:antiglomerular basement membrane antibody