Review Question - QID 107162

This patient has pulmonary hemorrhage and nephritic syndrome. His renal biopsy shows linear deposition of antibodies (to collagen type IV) along the basement membrane in the glomerulus, a finding characteristic of Goodpasture disease.

Goodpasture disease is a type II hypersensitivity reaction involving anti-GBM antibodies against the alpha-3 chain of collagen type IV. Antibodies to the alveolar basement membrane result in hemoptysis and lung disease. Goodpasture disease affects men more than women. Renal biopsy shows crescentic changes on pathology, and immunofluorescence staining shows anti-GBM antibodies, which are arranged in a linear distribution.

Figure A depicts an RBC cast, which suggests nephritic syndrome. Figure B shows immunofluorescence staining of a glomerulus in which the tagged fluorescent antibody is distributed in a linear pattern. Illustration A shows a biopsy segment displaying RPGN from a patient suffering from Goodpasture disease.

Incorrect Answers:
Answer 1: Goodpasture disease is a type II hypersensitivity reaction not type III.
Answer 3: C-ANCA disorders include granulomatosis with polyangiitis (Wegner's), which can cause pulmonary and renal symptoms. However, this diagnosis would not show a linear fluorescent staining pattern.
Answer 4: Tuberculosis is a mycobacterial infection that can affect many organ systems. However, this man does not have significant risk factors for tuberculosis, and his biopsy is diagnostic of Goodpasture disease.
Answer 5: He has not had weight loss or other systemic signs suggestive of metastatic malignancy. Moreover, his biopsy results are diagnostic of an autoimmune process.