Wegener's granulomatosis exhibiting the clinical features of Goodpasture's syndrome.

A case is reported here, the clinical features of which raised the suspicion of Goodpasture's syndrome which was, however, at variance with the absence of antiglomerular basement membrane antibodies. Renal failure improved on immunosuppressive treatment and peritoneal dialysis, but the patient died of gastric haemorrhage from a peptic ulcer related to steroid treatment. Necropsy and microscopic study revealed abnormalities of liver and spleen, consistent with Wegener's granulomatosis. Immunohistologic studies of the kidney confirmed the presence of granular-type IgG deposits in the glomeruli. There were extensive fibrin deposits in the kidney. The ways and means for the differentiation of Wegener's granulomatosis from Goodpasture's syndrome, the potential pathogenetic role of immunocomplexes and fibrin deposits, and the therapeutic possibilities are discussed.