A 19-year-old man presents to the emergency department complaining of coughing up blood and decreased urine output. On physical examination, there is normal air entry in the lungs, and the heart sounds are normal. There is no skin rash or palpable lymph nodes and his abdomen is normal. CXR reveals patchy infiltrates in both lower lobes and his creatinine is elevated. Urinalysis is positive for red cells and protein. A renal biopsy is performed and it reveals autoantibodies to basement membranes. Which of the following is the most likely diagnosis?
Correct Answer: Goodpasture syndrome
Description: Autoantibodies can be demonstrated by immunofluorescence or electron microscopy on the basement membranes of glomeruli and alveoli in Goodpasture syndrome. The disease is most common in young men but can strike at any age. The hemoptysis can be minimal or massive. The course of the hemoptysis is variable, but renal involvement is often progressive. Current therapy includes intensive plasma exchange, cytotoxic agents, and glucocorticoids. Other causes of lung renal syndromes such as various vasculitides, Wegener granulomatosis, mixed essential cryoglobulinemia, Henoch-Schonlein purpura, and systemic lupus erythematosus (SLE) are not characterized by antibodies to basement membranes.
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