Ronald Chong
Tan Tock Seng Hospital, Singapore
Title: GBM Disease: A Rare Case presenting as a rare cause of FUO
Biography
Biography: Ronald Chong
Abstract
Acute glomerulonephritis due to anti-GBM antibody disease is rare, estimated to occur in fewer than one case per million population. Patients usually present with acute renal failure with urinalysis showing proteinuria not in nephrotic range and a nephritic sediment characterized by dysmorphic red cells.
Systemic signs and signs, such as malaise, weight loss, fever, or arthralgia, are typically absent.
In this case study, a 38yo Chinese woman presented to us with a cough and fever for 3 months with a background history of treated latent pulmonary tuberculosis 2 years ago.
Positive findings for her on examination were fever with cough and sputum, weightloss of 5 kg and basic blood screening, she had iron deficiency anemia of haemoglobin 7.1, renal impairment(Cr194umol/L) and ESR >140 Sputum for acid fast bacilli, bronchoscopy, bone marrow aspirate and biopsy, ultrasound abdomen, auto immune screening were all negative including ANA, DsDNA, C3,c4,ANCA. Her anti GBM antibody was negative. Renal biopsy showed necrotizing and crescentic glomerulonephritis with inconclusive immunofluorescence studies.
Subsequent anti MPO and anti-GBM ELIZA was positive
She was subsequently treated with High dose IV methylprednisolone and plasma exchange which showed resolution of her persistent fevers and improvement in her renal function.