ABSTRACT
Examination This man has bibasal inspiratory crackles on auscultation of the chest. The rest of the cardiorespiratory, abdominal and neurological examination is normal. A chest X-ray shows bilateral patchy shadowing in the lower zones. Observations: blood pressure 165/85 mmHg, heart rate 85/min, respiratory rate 24/min, SaO2 92 per cent on room air.
nary haemorrhage, and the most likely diagnosis is Goodpasture’s syndrome. There are other causes of pulmonary renal syndromes and a definitive diagnosis relies on testing for anti-glomerular basement membrane antibody titre and a renal biopsy which will show crescentic glomerulonephritis and linear IgG staining. An ANCA (antineutrophil cytoplasmic antibodies) test should be performed to rule out Wegener’s granulomatosis, Churg-Strauss syndrome and microscopic polyarteritis. In 30-50 per cent of cases those with Goodpasture’s syndrome will also test positive for ANCA. Antinuclear antibody (ANA) and serum complement C3 and C4 are useful to exclude lupus nephritis.
