Anti-GBM Disease Following Ovarian Mesonephric-Like Adenocarcinoma: A Unique Insight Into Paraneoplastic Autoimmunity

Mesonephric-like adenocarcinoma (MLA) of the ovary is an exceptionally rare malignancy, and antiglomerular basement membrane (anti-GBM) disease has not previously been described in this setting. We report a 63-year-old woman with FIGO (Fédération Internationale de Gynécologie et d'Obstétrique) stage IIIA1(i) ovarian MLA who underwent complete cytoreduction followed by 6 cycles of carboplatin-paclitaxel. Four months after chemotherapy, she developed fatigue, hematuria, and rapidly progressive kidney failure; serology revealed high-titer anti-GBM antibodies. Despite urgent plasma exchange, high-dose corticosteroids, cyclophosphamide, rituximab, and maintenance hemodialysis, renal recovery was minimal. The close temporal sequence raises, but does not establish, a possible link between MLA, its cytotoxic treatment, and the emergence of anti-GBM autoimmunity, perhaps through chemotherapy-mediated alteration or exposure of glomerular antigens. Although causality remains speculative and additional cases are required for confirmation, our observation suggests that autoimmune vasculitides should remain within the differential diagnosis of otherwise unexplained fulminant kidney injury in patients with rare gynecological malignancies.