An unusual presentation of Goodpasture syndrome

Goodpasture disease is an anti-glomerular basement membrane (anti-GBM) disease that manifests as progressive glomerulopathy and alveolar hemorrhage. Our case was a 68-year-old female who presented with decompensated liver disease (DCLD) with no prior history suggestive of liver disease. She had dyspnea, bilateral pitting edema, icterus with normal renal parameters, and elevated liver enzymes. Ultrasonogram revealed shrunken liver, ascites, and portal hypertension with normal renal cortex echogenicity. Over the next three days, she developed progressive oliguria, hematuria, and breathlessness, with arterial blood gas showing hypoxia with acidosis and hyperkalemia. Bronchoscopic alveolar lavage was suggestive of hemorrhagic fluid. The patient succumbed to the disease in 24 hours. Anti-GBM antibodies came positive by immunofluorescence assay which confirmed the diagnosis of Goodpasture syndrome. Unusual presentation of DCLD in our case resulted in a delay in diagnosis that could have been crucial in altering the outcome.