Case Report
Goodpasture syndrome during the course of a Schönlein-Henoch purpura,☆☆

https://doi.org/10.1053/ajkd.2002.32799Get rights and content

Abstract

Two months after surgical resection of a bronchogenic carcinoma, a 69-year-old patient presented with Schönlein-Henoch purpura with kidney involvement followed by pulmonary hemorrhage. The presence of an IgA linear pattern on the kidney biopsy specimen and circulating anti-glomerular basement membrane (GBM) IgA antibodies led to the diagnosis of Goodpasture syndrome, which implies the possibility that the well-known pulmonary involvement during the course of Schönlein-Henoch purpura could be caused by Goodpasture syndrome in certain cases. In cases of glomerulonephropathy with lung involvement, clinicians should not limit their investigations to anti-GBM IgG. © 2002 by the National Kidney Foundation, Inc.

Section snippets

Case report

A 69-year-old patient had undergone surgery 2 months before admission to our department. The patient had been a smoker up to 2 months before admission, was hypertensive on medical treatment, and had a past medical history of bronchogenic squamous cell carcinoma in the right upper lobe (4.5 cm in diameter, infiltrating parietal pleura, without hilar or mediastinal lymph node involvement). A superior and medial bilobectomy had been performed with mediastinal lymphadenectomy and section of the

Discussion

The diagnosis of Goodpasture syndrome requires the demonstration of anti-GBM circulating antibodies and a characteristic linear pattern on direct immunofluorescence, which is usually IgG, but occasionally non-IgG antibodies can be present or both.4 Lung neoplasms have been noted among the precipitating factors that can trigger Schönlein-Henoch purpura.5 In the present case, although we did not have pathology samples of the pulmonary lesions, the presence of glomerulonephritis with linear IgA

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    Among 53 patients who presented with anti-GBM disease in 2 local renal units over the past 3 decades, this has been the only case of IgA-mediated disease that we have encountered. So far, only 13 cases have been reported in the literature.3–16 In all cases, the histology was consistent with crescentic glomerulonephritis and demonstrated linear GBM staining with IgA.

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Address reprint requests to Luis Carreras, MD, PhD, Scio de Nefrología, Hospital Princeps d'Espanya, CSUB, Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain. E-mail: [email protected]

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