Intrapulmonary hemorrhages and immune complex glomerulonephritis masquerading as Goodpasture's syndrome

The case of a patient who presented clinically with hemoptysis and was shown to have bilateral pulmonary infiltrates and renal abnormalities is described. This typical clinical setting was initially diagnosed as Goodpasture's syndrome. Open biopsies of lung and kidney were performed. Light microscopy failed to demonstrate the renal abnormalities most often associated with Goodpasture's syndrome. Immunofluorescence and electron microscopic findings were compatible with a diagnosis of immune complex glomerulonephritis. No immunologic lesions were demonstrated by lung biopsy. Antiglomerular basement membrane antibodies were not detected in the patient's serum. In view of the drastic prognostic and therapeutic consequences of Goodpasture's syndrome, it is essential that this diagnosis be confirmed by tissue examination and serologic testing.