Penicillamine-induced "Goodpasture's syndrome": successful treatment of a fulminant case

Goodpasture's syndrome is a recognised but rare complication of penicillamine therapy. Return of useful renal function has no been recorded with this complication. A patient is presented in whom aggressive management with plasmapheresis, haemodialysis and immunosuppression in the acute stage resulted in rapid control of pulmonary haemorrhage and return of useful renal function without the need for long-term haemodialysis. Immunofluorescence and electron microscopic studies of renal tissue together with the demonstration of circulating immune complexes, established the immune complex pathogenesis of this patient's disease. Microhaematuria is emphasised as an important warning sign of this complication.