Saudi Journal of Kidney Diseases and Transplantation

CASE REPORT
Year
: 2013  |  Volume : 24  |  Issue : 4  |  Page : 783--788

Double-positive Goodpasture俟Q製 syndrome with concomitant active pulmonary tuberculosis


Waqar Kashif1, Sonia Yaqub1, Syed Faisal Mahmood2, Junaid Patel3 
1 Section of Nephrology, Department of Medicine, Aga Khan University, Karachi, Pakistan
2 Section of Infectious Disease, Department of Medicine, Aga Khan University, Karachi, Pakistan
3 Section of Internal Medicine, Department of Medicine, Aga Khan University, Karachi, Pakistan

Correspondence Address:
Waqar Kashif
Department of Medicine, Aga Khan University, P. O. Box 3500, Stadium Road, Karachi
Pakistan

Anti-glomerular basement membrane (anti-GBM) disease usually presents as rapidly progressive glomerulonephritis, and, when accompanied with pulmonary hemorrhage, it is called Goodpasture俟Q製 syndrome. Anti-neutrophilic cytoplasmic antibodies (ANCA) may co-exist with anti-GBM antibodies. In most of these 非Q蜿ouble positive非Q cases, ANCA is specific for myeloperoxidase (p-ANCA). We report a rare case of a critically ill patient c-ANCA-associated double-positive Goodpasture俟Q製 syndrome with concomitant tuberculosis that was successfully treated with immunosuppression, plasmapheresis and anti-tuberculous therapy (ATT). A 32-year-old gentleman with a 15 pack-year smoking history presented with massive hemoptysis, respiratory failure and oliguria. Laboratory investigation revealed anemia, elevated creatinine and active urinary sediment. Chest X-ray revealed bilateral pulmonary infiltrates. Broad-spectrum antibiotics and intravenous corticosteroids were started. Bronchoscopy showed alveolar hemorrhage and smears from bronchial lavage from both lungs were positive for acid fast bacillus (AFB). Vasculitis work-up revealed high titers of c-ANCA and anti-GBM antibodies. Kidney biopsy revealed crescents in >50% glomeruli on light microscopy. Immunofluorescence showed linear deposition of IgG and C3. The patient received pulse methylprednisone for three days followed by oral prednisone and ATT. In addition, he also underwent nine sessions of plasmapheresis. Oral Cyclophosphamide was added on Day 10. The patient showed remarkable recovery as his lung fields cleared and his kidney function got stabilized. Cyclophosphamide was continued for three months and then switched to azathioprine. At six months, the creatinine is 1.2 mg/dL, with minimal proteinuria and a normal chest X-ray. To the best of our knowledge, this is the only reported case of double-positive Goodpasture俟Q製 syndrome (c-ANCA and anti GBM) with active tuberculosis treated successfully.


How to cite this article:
Kashif W, Yaqub S, Mahmood SF, Patel J. Double-positive Goodpasture's syndrome with concomitant active pulmonary tuberculosis.Saudi J Kidney Dis Transpl 2013;24:783-788


How to cite this URL:
Kashif W, Yaqub S, Mahmood SF, Patel J. Double-positive Goodpasture's syndrome with concomitant active pulmonary tuberculosis. Saudi J Kidney Dis Transpl [serial online] 2013 [cited 2021 Dec 8 ];24:783-788
Available from: https://www.sjkdt.org/article.asp?issn=1319-2442;year=2013;volume=24;issue=4;spage=783;epage=788;aulast=Kashif;type=0