Massive pulmonary hemorrhage and fulminant renal failure associated with immune complex glomerulonephritis

A 54-year-old man had massive pulmonary hemorrhage and fulminant renal failure. Although his clinical presentation was similar to that of Goodpasture's syndrome, his renal disease was associated with deposition of immune complex rather than with production of antiglomerular basement membrane antibody. Serum cryoglobulins were present, presumptive evidence of circulating immune complexes; serum antiglomeral basement membrane antibodies were absent. Renal biopsy revealed a crescentic, exudative glomerulonephritis with a granular immunofluorescence pattern; subepithelial deposits were demonstrated by electron microscopy. This immune complex glomerulonephritis was thought possibly to be postinfectious in origin, with characteristics distinguishing it from Goodpasture's syndrome. Pulmonary hemorrhage and crescentic immune-complex-mediated glomerulonephritis are reviewed.