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Diffuse Lung Disease |

Isolated Pulmonary Involvement in Anti-Glomerular Basement Membrane Disease FREE TO VIEW

Michelle Homan, DO; Usman Nazir, MD; Amanda Schnell, MD; Timothy Williamson, MD
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Kansas University, Fairway, KS


Chest. 2015;148(4_MeetingAbstracts):367A. doi:10.1378/chest.2280919
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Abstract

SESSION TITLE: Diffuse Lung Disease Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Anti-Glomerular Basement Membrane Disease (anti-GBM) is a pulmonary-renal syndrome, which commonly affects both organ systems or has renal only involvement. Pulmonary only involvement, while rare, can be an initial presentation of diffuse alveolar hemorrhage.

CASE PRESENTATION: Twenty seven year old male presents with acute shortness of breath. Seven days prior to admission presented with mild dyspnea fever, chills and myalgia. There was exposure to ill contacts, which included an infant and another older child. He had previous history of tobacco use. Exposure history was pertinent for chlorine gas and concrete spraying. He started to have productive cough of white to yellow sputum and went to his primary care physician. Levofloxacin and albuterol were prescribed without any improvement in symptoms. The patient continued to have worsening dyspnea and presented again to his primary care physician where his Sp02 was 80% on room air and he was taken to the nearest emergency room. Respiratory failure prompted intubation, mechanical ventilation and transfer to the University of Kansas Hospital. Upon admission chest x-ray was remarkable for five lobe alveolar infiltrate. Laboratory evaluation showed hemoglobin 8.3.gm/dl and creatinine 0.5mg/dl. Urinalysis was unremarkable. Bronchoscopy with BAL was performed and was remarkable for progressively bloody return compatible with diffuse alveolar hemorrhage. Serology was remarkable for glomerular basement membrane Ab for IgG 2.8. High dose corticosteroids, plasma exchange and cyclophosphamide were initiated. Cyclophosphamide was later transitioned to azathioprine. Symptoms of dyspnea along with anemia have improved.

DISCUSSION: This case illustrates a rare presentation of isolated pulmonary involvement of anti-GBM disease (limited Goodpasture’s syndrome) without renal dysfunction. This presentation of anti-GBM disease is far less frequent than pulmonary-renal syndrome or isolated renal impairment.

CONCLUSIONS: Although rare, pulmonary only anti-GBM disease or limited Goodpasture’s syndrome is a rare cause of diffuse alveolar hemorrhage without evidence of systemic illness.

Reference #1: McPhaual JJ Jr., Mullins JD: Glomerulonephritis mediated by antibody to glomerular basement membrane. Immunological, clinical, and histopathological characterisitcs. J Clin Invest. 57:351.

DISCLOSURE: The following authors have nothing to disclose: Michelle Homan, Usman Nazir, Amanda Schnell, Timothy Williamson

No Product/Research Disclosure Information


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