A Rare Case of Goodpasture's Syndrome Combined with Polyarteritis Nodosa

A 75-year-old man with a fever, shoulder pain, and lower leg edema was diagnosed with polymyalgia rheumatica and started on glucocorticoid therapy. Eighteen months later, he was admitted with rapidly progressive renal failure. Glucocorticoid therapy had been discontinued one month prior to admission. Serum anti-glomerular basement membrane antibodies were elevated, and a kidney biopsy revealed fibrinoid necrosis of the medium-sized renal arteries, tubulointerstitial nephritis, and collapsed glomeruli. An immunofluorescence study showed mild immunoglobulin G linear deposition. Polyarteritis nodosa was diagnosed based on the presence of fibrinoid necrosis in the medium-sized renal arteries. Glucocorticoid pulse therapy and plasmapheresis were initiated, but the patient died of alveolar hemorrhaging. This was a rare case of Goodpasture's syndrome with polyarteritis nodosa.