[A case of Goodpasture's syndrome complicated with cytomegalovirus pneumonia during treatment with plasma exchange and immunosuppressive therapy].

A 63-year-old man presented to another hospital with hematuria and an elevated serum creatinine level. He was admitted, and hemodialysis was initiated. One month after admission, hemoptysis developed and the patient was referred to our hospital for further evaluation. Goodpasture's syndrome was diagnosed on the basis of elevated anti-glomerular basement membrane (anti-GBM) antibody levels. Due to massive alveolar hemorrhage, the patient was treated with plasma exchanges, pulse methylprednisolone and pulse cyclophosphamide followed by oral prednisolone, which lowered his anti-GBM antibody level. However, a chest radiograph obtained on the 56th hospital day showed bilateral ground glass opacities, and his condition deteriorated. Since his blood was positive for the cytomegalovirus pp65 antigen, ganciclovir was started. This improved his condition, with improvement in his chest radiograph and a decrease in the number of antigen-positive cells. It is important to consider the development of cytomegalovirus infection during the treatment of Goodpasture's syndrome with immunosuppressive therapy.