Boardman Emily Ann, Sohail Sameira, Yadavilli Rajesh
Cardiff University, Cardiff, South Glamorgan, UK.
Royal Bolton Hospital NHS Foundation Trust, Bolton, UK.
BMJ Case Rep. 2017 Mar 17;2017:bcr2016218705. doi: 10.1136/bcr-2016-218705.
Goodpasture's disease without circulating autoantibodies is a rare presentation of a rare diagnosis. We present the case of a man aged 17 years who had 3 hospital admissions over a 2-month period with haemoptysis and shortness of breath. Throughout his first 2 admissions, his renal function was normal and anti-glomerular basement membrane (GBM) antibodies were negative. CT pulmonary angiogram during his second admission revealed florid and diffuse alveolar infiltrates. However, high-resolution CT chest performed 4 weeks later showed complete resolution of these changes. On his third admission, he developed acute kidney injury. A repeat CT chest revealed the reappearance of initial findings and anti-GBM antibodies were now positive. Goodpasture's disease was subsequently confirmed with renal biopsy. Our case, with delayed onset of renal impairment, initial seronegativity for anti-GBM antibodies and relapsing and remitting CT findings, emphasises the need to consider this diagnosis in the setting of otherwise unexplained pulmonary haemorrhage.
无循环自身抗体的肺出血肾炎综合征是一种罕见诊断的罕见表现。我们报告一例17岁男性病例，该患者在2个月内因咯血和呼吸急促3次入院。在其前两次入院期间，他的肾功能正常，抗肾小球基底膜（GBM）抗体呈阴性。第二次入院时的CT肺动脉造影显示有明显的弥漫性肺泡浸润。然而，4周后进行的胸部高分辨率CT显示这些改变完全消退。第三次入院时，他出现了急性肾损伤。重复胸部CT显示最初的表现再次出现，此时抗GBM抗体呈阳性。随后通过肾活检确诊为肺出血肾炎综合征。我们的病例，肾功能损害出现延迟，抗GBM抗体最初呈血清阴性，CT表现复发和缓解，强调在不明原因的肺出血情况下需要考虑这一诊断。
