A 19-year-old man presents with coughing up blood and decreased urine output. On examination, he has normal air entry, and heart sounds. There is no skin rash or lymph nodes and his abdomen is normal. CXR reveals patchy infiltrates in both lower lobes and his creatinine is elevated. Urinalysis is positive for red cells and protein. A renal biopsy reveals autoantibodies to basement membranes. Which of the following is the most likely diagnosis?
Autoantibodies can be demonstrated by immunofluorescence or electron microscopy on the basement membranes of glomeruli and alveoli in Goodpasture's syndrome. The disease is most common in young men but can strike at any age. The hemoptysis can be minimal or massive. The course of the hemoptysis is variable, but renal involvement is often progressive. Current therapy includes intensive plasma exchange, cytotoxic agents, and glucocorticoids. Other causes of lung-renal syndromes such as various vasculitides, Wegener's granulomatosis, mixed essential cryoglobulinemia, Henoch-Schonlein purpura, and systemic lupus erythematosus (SLE) are not characterized by antibodies to basement membranes.
thyroiditis
myasthenia gravis
Goodpasture's syndrome
thrombocytopenia
Immunology and Rheumatology