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Multiple recurrences of anti-glomerular basement membrane disease with variable antibody detection: can the laboratory be trusted?

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ABSTRACT

Anti-glomerular basement membrane (GBM) disease is commonly a monophasic illness. We present the case of multiple recurrences of anti-GBM disease with varying serum anti-GBM antibody findings. A 33-year-old female tobacco user presenting with hematuria was diagnosed with anti-GBM disease by renal biopsy. Five years later, she presented with alveolar hemorrhage and positive anti-GBM antibody. She presented a third time with alveolar hemorrhage but undetectable anti-GBM antibody. With each occurrence, symptoms resolved with plasmapheresis, intravenous methylprednisone and oral cyclophosphamide. The relationship between anti-GBM antibody findings and disease presentation is complex. Clinicians should be aware of the possibility of seronegative anti-GBM disease.

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Chest plain film x-ray during admission in 2014 revealed extensive perihilar opacities.
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SFW038F2: Chest plain film x-ray during admission in 2014 revealed extensive perihilar opacities.

Mentions: In 2014, 8 years after her relapse, she presented with epistaxis and hemoptysis. On presentation, hemoglobin was 12.0 g/dL and serum creatinine was 0.57 mg/dL. Urine analysis revealed microhematuria with 1+ hemoglobin. Chest x-ray showed bilateral perihilar opacities consistent with diffuse alveolar hemorrhage (Figure 2). During this admission, her serum-anti-GBM antibody was negative. She was again treated as a presumed anti-GBM relapse with plasmapheresis for 7 days, cyclophosphamide 2 mg/kg/day for 3 months and methylprednisone 1 g IV daily for three doses followed by oral prednisone 60 mg/day for 2 months. During this most recent hospitalization, she was initially admitted to the ICU for plasmapheresis then transferred to the general medicine service after 1 day due to stability. She required no supplemental oxygen during the course of her 8-day hospitalization.Fig. 2.


Multiple recurrences of anti-glomerular basement membrane disease with variable antibody detection: can the laboratory be trusted?
Chest plain film x-ray during admission in 2014 revealed extensive perihilar opacities.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5036896&req=5

SFW038F2: Chest plain film x-ray during admission in 2014 revealed extensive perihilar opacities.
Mentions: In 2014, 8 years after her relapse, she presented with epistaxis and hemoptysis. On presentation, hemoglobin was 12.0 g/dL and serum creatinine was 0.57 mg/dL. Urine analysis revealed microhematuria with 1+ hemoglobin. Chest x-ray showed bilateral perihilar opacities consistent with diffuse alveolar hemorrhage (Figure 2). During this admission, her serum-anti-GBM antibody was negative. She was again treated as a presumed anti-GBM relapse with plasmapheresis for 7 days, cyclophosphamide 2 mg/kg/day for 3 months and methylprednisone 1 g IV daily for three doses followed by oral prednisone 60 mg/day for 2 months. During this most recent hospitalization, she was initially admitted to the ICU for plasmapheresis then transferred to the general medicine service after 1 day due to stability. She required no supplemental oxygen during the course of her 8-day hospitalization.Fig. 2.

View Article: PubMed Central - PubMed

ABSTRACT

Anti-glomerular basement membrane (GBM) disease is commonly a monophasic illness. We present the case of multiple recurrences of anti-GBM disease with varying serum anti-GBM antibody findings. A 33-year-old female tobacco user presenting with hematuria was diagnosed with anti-GBM disease by renal biopsy. Five years later, she presented with alveolar hemorrhage and positive anti-GBM antibody. She presented a third time with alveolar hemorrhage but undetectable anti-GBM antibody. With each occurrence, symptoms resolved with plasmapheresis, intravenous methylprednisone and oral cyclophosphamide. The relationship between anti-GBM antibody findings and disease presentation is complex. Clinicians should be aware of the possibility of seronegative anti-GBM disease.

No MeSH data available.


Related in: MedlinePlus