Immunopathologic features of a patient with glomerulonephritis and pulmonary hemorrhage

Described here is a patient who had pulmonary hemorrhage associated with glomerulonephritis. Serologic data revealed the presence of circulating cold agglutinins, a positive Coombs test and positive antinuclear factor. Serum total hemolytic complement levels and serum complement component Clq levels were low throughout the patient's course. The patient also exhibited precipitating antibodies against calf thymus nuclear extract and rabbit liver ribosomes. In addition, rheumatoid factor precipitable material was detected in the serum early in the patient's course. Immunofluorescent studies revealed deposition of immunoglobulin G (IgG) on the glomerulus in a pattern analogous to that which occurs in experimental “immune-complex” induced glomerulonephritis. Our findings suggest that the patient's disease was associated with circulating and deposited antigen-antibody complexes. The pathogenesis of the renal lesion in this instance is therefore distinctive from that previously described in patients with pulmonary hemorrhage and nephritis and said to have Goodpasture's syndrome, which is usually associated with antiglomerular basement membrane antibodies.