Goodpasture syndrome complicated with lung infection: a case report and literature review

Objective To investigate the clinical characteristics， diagnosis and treatment of Goodpasture syndrome complicated with lung infection. Methods Clinical data of one case of Goodpasture syndrome complicated with pulmonary infection were retrospectively analyzed. Literature review was performed from PubMed， Embase， Web of Science， China National Knowledge Infrastructure （CNKI） and Wanfang Data Knowledge Service platform using “Goodpasture syndrome” and “infection” as search terms from the database inception date to September 2022. Clinical manifestations and prognosis of Goodpasture syndrome complicated with pulmonary infection were summarized. Results The 51-year-old male patient， was admitted to our hospital due to elevated serum creatinine level for more than one month and blood in sputum for over 10 d. The patient had a cough of yellow-green purulent sputum. Moist rales were heard in bilateral lungs. Renal biopsy showed crescentic glomerulonephritis， and anti-glomerular basement membrane IgG antibody was weakly positive. Chest CT scan revealed multiple inflammations in both lungs. The culture of bronchoalveolar lavage fluid showed the phenomenon of phagocytosis. Sputum fungal smear and fluorescent staining， alveolar lavage fluid culture， next-generation sequencing （NGS） of alveolar lavage fluid indicated a variety of microbial infections. The diagnosis of Goodpasture syndrome complicated with lung infection was considered. He was discharged after receiving renal replacement， immunosuppression， and anti-infection therapies. Three months later， the patient was transferred to ICU due to “severe pneumonia， septic shock， and respiratory failure” and eventually died. A total of 27 cases of Goodpasture syndrome complicated with pulmonary infection were researched. The common pathogens of pulmonary infection were invasive pulmonary Aspergillus， Pneumocystis carinii， Mycobacterium tuberculosis and cytomegalovirus， etc. Thirteen patients died， and 4 of them died of respiratory failure and/or respiratory infection. Conclusion Extensive attention should be diverted to the risk of infection in patients with Goodpasture syndrome， especially severe lung infection.