GOODPASTURE SYNDROME: CASE REPORT

  • I.I. Starchenko Ukrainian Medical Stomatological Academy, Poltava
  • N.I. Vynnyk Ukrainian Medical Stomatological Academy, Poltava
  • S.M. Sovhyria Ukrainian Medical Stomatological Academy, Poltava
  • B.M. Filenko
  • S.А. Proskurnia Ukrainian Medical Stomatological Academy, Poltava
  • N.V. Royko Ukrainian Medical Stomatological Academy, Poltava
  • A.P. Khazanov Poltava Regional Bureau of Autopsy, Poltava
Keywords: Goodpasture syndrome, glomerulonephritis, hemorrhagic pneumonitis, phlegmonous appendicitis, pulmonary hemorrhage

Abstract

The Goodpasture syndrome is an immune-inflammatory pathology characterized by the formation of autoantibodies directed against the basement membranes of the renal glomeruli and pulmonary alveoli, manifested by hemorrhagic pneumonitis in combination with pulmonary hemorrhage (hemoptysis) and glomerulonephritis. To date, etiological mechanisms of the disease are unknown. Clinical observations indicate a relationship between the development of Goodpasture syndrome and viral infection, intake of medications, industrial hazards. The incidence of Goodpasture syndrome is estimated to be 1 case per 1 million population. Due to the rarity of this pathology, each case of Goodpasture syndrome is of great theoretical and practical interest. The authors conducted the analysis of clinical and morphological observation of Goodpasture syndrome. The postmortem study revealed morphological signs indicating the presence of Goodpasture syndrome inter vivos, whose main manifestations were hemorrhagic pneumonitis and mesangial-proliferative glomerulonephritis with fibroplastic transformation. The reported case is also of particular interest in terms of correct formulation of the final diagnosis, since there was a combination of two diseases: Goodpasture syndrome and phlegmonous appendicitis with focal peritonitis. In this case, pulmonary heart failure should be considered as the direct cause of death, since pulmonary lesions prevailed over the renal ones, which is fully consistent with the clinical presentation and findings of the laboratory tests. The diagnosis of Goodpasture syndrome made at the hospital is not always timely, as can be evidenced by patient’s severe condition, and it requires careful differentiation with a number of other diseases involving hemorrhagic pulmonary and renal syndrome, and the urgent need for active therapy with immunosuppressants, including prednisone and cytostatics. The timely adequate treatment significantly improves the prognosis.

Downloads

Download data is not yet available.

References

1. Ardashev V, Potehin N, Malysheva S, Borisov A. Goodpasture syndrome. Vrach, 2006;(6):8-11.
2. Bergs L Goodpasture syndrome. Crit Care Nurs 9. 2005;25:50–8.
3. Chan AL, Louie S, Leslie KO, Juarez MM, Albertson TE. Cutting edge issues in Goodpasture's disease. Clin Rev Allergy Immunol. 2011 Oct;41(2):151-62. doi: 10.1007/s12016-010-8222-2.
4. Cranfield A., Mathavakkannan S. Goodpasture's disease following extracorporeal shock wave lithotripsy: a case report & literature review. Clin. Case Rep. 2015; 3(3):160-164.
5. Cui Z, Zhao MH, Xin G et al. Characteristics and prognosis of Chinese patients with anti-glomerular basement membrane disease. Nephron Clin Pract. 2005; 99: 49–55.
6. Dammacco F, Battaglia S, Gesualdo L, Racanelli V. Goodpasture's disease: a report of ten cases and a review of the literature. Autoimmun Rev. 2013 Sep;12(11):1101-8. doi: 10.1016/j.autrev.2013.06.014.
7. Fernandes R, Freitas S, Cunha P, Alves G, Cotter J. Goodpasture’s syndrome with absence of circulating anti-glomerular basement membrane antibodies: a case report. J Med Case Rep. 2016 Jul 27;10:205. doi: 10.1186/s13256-016-0984-6.
8. Goodpasture EW. Landmark publication from The American Journal of the Medical Sciences: The significance of certain pulmonary lesions in relation to the etiology of influenza. Am J Med Sci. 2009 Aug;338(2):148-51. doi: 10.1097/MAJ.0b013e31818fff94.
9. Greco A, Rizzo MI, De Virgiio A, et al. Goodpasture's syndrome: a clinical update. Autoimmun Rev. 2015 Mar;14(3):246-53. doi: 10.1016/j.autrev.2014.11.006.
10. Hellmark T, Segelmark M. Diagnosis and classification of Goodpasture's disease (anti-GBM). J Autoimmun. 2014 Feb-Mar;48-49:108-12. doi: 10.1016/j.jaut.2014.01.024.
11. Hirayama K, Yamagata K, Kobayashi M et al. Anti-glomerular basement membrane antibody disease in Japan: part of the nationwide rapidly progressive glomerulonephritis survey in Japan. Clin Exp Nephrol 2008; 12: 339–347.
12. Jennette JC, Falk RJ, Bacon PA, et al. 2012 Revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum. 2013 Jan;65(1):1-11. doi:10.1002/art.37715.
13. Katerenchuk IP, Talash VV, Shperno OH, Hryn KV, Yarmola TI. Syndrom Hudpaschera: klinichni sposterezhennia. Praktykuiuchyi likar. 2018; 3 (27): 25-35.
14. Korol TM. Vchennia pro diahnoz yak vazhlyvyi rozdil biopsiino-sektsiinoho kursu dlia formuvannia klinichnoho myslennia u maibutnikh likariv. Biomedical and biosocial anthropology. 2013; 20: 156-9.
15. Levy JB, Hammad T, Coulthart A et al. Clinical features and outcome of patients with both ANCA and anti-GBM antibodies. Kidney Int 2004; 66:1535–1540.
16. Segelmark M, Hellmark T, Wieslander J. The prognostic significance in Goodpasture’s disease of specificity, titre and affinity of anti-glomerularbasement-membrane antibodies. Nephron Clin Pract 2003; 94: 59–68.
17. Shah MK, Hugghins SY. Characteristics and outcomes of patients with Goodpasture's syndrome. South Med J. 2002 Dec;95(12):1411-1418. PMID: 12597309.
Published
2019-12-16
How to Cite
Starchenko, I., Vynnyk, N., Sovhyria, S., Filenko, B., Proskurnia, S., Royko, N., & Khazanov, A. (2019). GOODPASTURE SYNDROME: CASE REPORT. The Medical and Ecological Problems, 23(5-6), 56-59. https://doi.org/10.31718/mep.2019.23.5-6.10