Professor of Medicine Albert Einstein Medical Center
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Introduction: Anti-glomerular basement membrane (anti-GBM) disease, historically called Goodpasture’s disease, is a small vessel vasculitis that leads to rapidly progressive glomerulonephritis. This condition features autoantibodies that target collagen chains found in alveolar and glomerular membranes, which can lead to a constellation of alveolar hemorrhage and renal failure referred to as Goodpasture’s syndrome. Despite the proposed association between anti-GBM disease and upper respiratory tract infections (URI), few cases have been reported. Herein we present a case of anti-GBM disease after URI.
Description: A 62-year-old woman presented with one week of progressive edema and anuria after recent URI. Two weeks earlier she had gone to primary care for cough and sore throat and was prescribed oseltamivir without microbial testing. Admission labs revealed a creatinine of 15 mg/dL, a marked increase from previously normal renal function. Testing for SARS-CoV-2, influenza A and B, RSV, HIV, and anti-streptolysin O were negative. Hemodialysis (HD) was initiated. Renal biopsy findings were consistent with anti-GBM disease. The patient developed respiratory distress due to flash pulmonary edema and was transferred to the MICU. The patient was treated with nitroglycerin drip, continued HD, plasmapheresis, and pulse-dose corticosteroids. After multidisciplinary discussion, cyclophosphamide was initiated. The patient required HD until time of discharge.
Discussion: Anti-GBM disease is a rare and incompletely understood autoimmune condition, with the exact mechanism of antibody formation remaining unclear. Environmental factors, antecedent illness (particularly viral URIs), and tissue injury have been proposed as inciting factors in the genetically susceptible. Despite the long-standing proposed association between anti-GBM disease and viral illness, only a limited number of cases have been reported in the literature. Our literature review found only 5 cases linked to influenza, with other rare cases linked to CMV and HIV. Most reports were linked to COVID-19 and the COVID-19 vaccine, which may reflect public interest over true increased incidence. While microbial testing did not reveal the culprit pathogen in this patient, this case highlights the uncertainties that remain for this rare illness.
