Case Report of a Patient with Goodpasture’s Syndrome Who Relapsed While on Hemodialysis

Goodpasture’s syndrome is a rare autoimmune disease in which anti-glomerular basement membrane antibodies damage the glomerular and alveolar basement membrane. Its relapse is very rare, compared to other pulmonary-renal syndromes. Herein, we present an unusual case of Goodpasture’s syndrome, which recurred despite immunosuppressive treatment. After the initial treatment with corticosteroid and cyclophosphamide pulses, plasmapheresis, alveolar hemorrhage ended, and the anti-glomerular basement membrane antibody finding became negative, but hemodialysis had to be continued. After 8 months of hemodialysis, anti-glomerular basement membrane antibodies were re-detected, and hemoptysis occurred a month later. Then, plasmapheresis, intravenous immunoglobulin, and methylprednisone were given in addition to azathioprine treatment; however, the serum anti-glomerular basement membrane antibody positivity persisted.

Relapse of this syndrome is rare, and if observed, it generally strikes years following disappearance of anti-glomerular basement membrane antibodies; however, in our case, relapse was observed within a few months. It should be kept in mind that, in patients who achieve remission following immunosuppressive therapy, clinical and serological relapses are rare, and the anti-glomerular basement membrane antibody positivity may persist despite the application of immunosuppressive agents in subjects who relapsed.