iatroX Rounds #46
The clues
- 1
A 32-year-old male presents with a two-week history of worsening breathlessness and a cough productive of blood-streaked sputum.
- 2
He mentions that he has also noticed his urine has become darker, appearing a smoky or cola-like colour.
- 3
The patient is a current smoker and mentions he recently recovered from a viral upper respiratory tract infection.
- 4
Bedside urinalysis reveals 3+ blood and 2+ protein, and his blood pressure is elevated at 155/94 mmHg.
- 5
Blood tests show a creatinine of 340 micromol/L, an acutely reduced renal function, and a normocytic anaemia.
- 6
Serology is positive for antibodies against the alpha-3 chain of type IV collagen; renal biopsy shows linear IgG deposits along the capillary walls.
Goodpasture syndrome is a rare autoimmune condition caused by antibodies attacking type IV collagen. This typically results in a pulmonary-renal syndrome consisting of alveolar haemorrhage and rapidly progressive glomerulonephritis.
- Haemoptysis and breathlessness due to pulmonary haemorrhage
- Haematuria and acute kidney injury due to glomerulonephritis
- Smoking and recent viral infection are known triggers for lung involvement
- Classically affects young men in their 20s to 30s
for education and entertainment. not medical advice.