Goodpasture syndrome

Last revised by Dr Joshua Yap on 27 Jul 2022

Goodpasture syndrome, also referred as antiglomerular basement membrane (anti-GBM) antibody disease, is an autoimmune disease characterized by damage to the alveolar and renal glomerular basement membranes by a cytotoxic antibody. It is a type of pulmonary-renal syndrome.

Goodpasture syndrome is defined by:

It typically affects young adult men with an M:F of 3:1. 

Patients may present with cough, dyspnea, hemoptysis and hypoxia. Pulmonary manifestations are usually the cause of presentation although most also have evidence of renal disease. 

Goodpasture syndrome is a type II hypersensitivity reaction with antibodies primarily directed against type IV collagen of the renal glomerular basement membrane. There is further cross-reactivity with the alveolar basement membrane resulting in pulmonary injury. This is typically characterized by rapidly progressive glomerulonephritis (RPGN) and necrotizing hemorrhagic interstitial pneumonitis respectively.

The diagnosis is made by immunofluorescent studies of renal or lung tissue, which show a smooth wavy line of fluorescent staining along the basement membrane. 

  • non-specific, bilateral, coalescent airspace opacities, which resolve in several days to give reticular opacities in the same distribution
  • complete radiographic resolution is usually seen within 2-3 weeks
  • ground glass and airspace opacities that progress to reticular "crazy paving" pattern over a few weeks
  • hilar lymphadenopathy may be seen
  • no interlobular septal thickening in the acute phase

The overall prognosis is poor, although the use of immunosuppressive drugs and plasmapheresis has improved survival.

Often radiograph and CT findings are indistinguishable from pulmonary edema. Other causes of pulmonary hemorrhage should also be considered. 

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Cases and figures

  • Case 1
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  • Case 2
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  • Case 3: isolated pulmonary involvement
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  • Case 4
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