Abstract
A 38-year-old female was referred to our hospital for clinical evaluation and treatment of renal failure associated with hemoptysis. On admission, marked hypoxemia was noted. Chest X-ray showed the patchy distribution of a mottled shadow in the bilateral lower lung, which rapidly extended over the whole pulmonary field within 3 days. Hemoptysis was also aggravated, accompanied by a rise of serum creatinine level from 2.1 to 3.7mg/dl Prednisolone (60mg/day) and plasmapheresis were then instituted. After 3 consecutive plasmaphereses, the abnormal pulmonary shadow and hemoptysis subsided markedly. Creatinine level also decreased to 2.5mg/dl Steroid was then decreased, but plasmapheresis was repeated until chest X-ray findings had improved completely. Renal biopsy was then performed. The biopsy specimen disclosed cresecentic glomerulonephritis by light microscopy and electron dense deposits in the mesangial area by electron microscopy. Intravenous administration of 1.0g of methylprednisolone for 3 consecutive days followed by maintenance doses of 30mg/day resulted in a further decrease in serum creatinine to 1.0mg/dl Anti-GBM antibody was not detected. Therefore, the diagnosis of Goodpasture's syndrome was not substantiated. Nevertheless, it seems likely that plasmapheresis contributed to the favorable outcome of this disease by eliminating some circulating pathogenic factors responsible for pulmonary and renal injury.
