title: Goodpasture's Disease: An Uncommon Disease With an Atypical Clinical Course.
abstract: Goodpasture's disease is an uncommon composite of features including renal failure with pulmonary hemorrhage secondary to an autoimmune response that specifically targets these organ systems. We present a case of particular interest in regards to atypical presentation, and the uncommon treatment that the patient underwent. A 65-year-old Afghani female arrived with complaints of nausea, vomiting, loss of appetite, malaise, decreased urine output, exertional dyspnea, and cough. The patient presented initially with renal failure and unexpectedly developed respiratory failure after hemodialysis. Initial CT of thorax revealed diffuse bilateral pulmonary edema. Subsequently, the patient received a bronchoscopy demonstrating alveolar hemorrhage, which highlights a clinician's need to maintain a differential and reassess patients. Anti-GBM antibody in the serum was detected and the renal biopsy revealed evidence of the antibody on immunofluorescence. In regards to management, the patient could only be treated with plasmapheresis as she had contraindication to initiation of immunosuppression, after which she showed significant clinical improvement. We would like to highlight the benefit of plasmapheresis without concomitant immunosuppression and recommend such an approach to be considered in similar clinical scenarios, where contraindication for immunosuppressant therapy exists.
authors.affiliation: Department of Medicine, Nassau University Medical Center, East Meadow, NY, USA.
authors.forename: Bethel
authors.initials: B
authors.lastname: Shiferaw
authors.affiliation: Department of Medicine, Nassau University Medical Center, East Meadow, NY, USA.
authors.forename: Viktor
authors.initials: V
authors.lastname: Miro
authors.affiliation: Department of Medicine, Nassau University Medical Center, East Meadow, NY, USA.
authors.forename: Carroll
authors.initials: C
authors.lastname: Smith
authors.affiliation: Department of Medicine, Nassau University Medical Center, East Meadow, NY, USA ; Division of Pulmonary and Critical Care, Nassau University Medical Center, East Meadow, NY, USA.
authors.forename: Jagadish
authors.initials: J
authors.lastname: Akella
authors.affiliation: Department of Medicine, Nassau University Medical Center, East Meadow, NY, USA ; Division of Pulmonary and Critical Care, Nassau University Medical Center, East Meadow, NY, USA.
authors.forename: Walter
authors.initials: W
authors.lastname: Chua
authors.affiliation: Department of Medicine, Nassau University Medical Center, East Meadow, NY, USA ; Division of Nephrology, Nassau University Medical Center, East Meadow, NY, USA.
authors.forename: Zae
authors.initials: Z
authors.lastname: Kim
keywords: Anti-GBM antibody; Atypical clinical course; Goodpasture’s disease; Plasmapheresis; Pulmonary hemorrahge; Renal failure