Pôster:

Goodpasture´s Syndrome or Glomerular basement antimembrane disease (anti-GBM) is a rare disease that mainly affects the kidneys and lungs. It is not related to rheumatoid arthritis and is classified as a vasculitis of small vessels mediated by immunocomplexes.

Case report

A 63-year-old female with rheumatoid arthritis (anti-ccp reagent) since 2008, controlled with methotrexate, was admitted on 09/2018 with dyspnea, cough, hemoptysis, peripheral edema and hypertension. Laboratory tests showed bloodand protein urine and loss of renal function. Thoracic tomography was performed, showing diffuse bilateral frosted glass and bronchoscopy with hematotic rests and bronchoalveolar lavage with an increase in red blood cell count. Made investigation for infectious process (Tuberculosis, leptospirosis and hantavirus) that were negative. It presented negative anti-nucleus antibody, but antimyeloperoxidase antibodies positive in two doses. Had done a renal biopsy that showed immunofluorescence with a diffuse IgG deposition in capillary loops with a linear pattern, strongly suggestive of glomerular basal antimembrane disease (anti-GBM). Pulse therapy was initiated with methylprednisolone and cyclophosphamide. The patient evolved with some infectious intercurrences in the period, but dyspnea and hemoptysis ceased and her renal function reverted after the third cyclophosphamide pulse. The dosage of glomerular basement antimembrane antibody was negative but renal biopsy was pathognomonic for the disease.

Conclusion

This is a rare case of Goodpasture´s Syndrome in patient with Rheumatoid Arthritis. Despite the presence of antimyeloperoxidase antibodies, there was moderate linear deposition of IgG in the glomerular basement membrane which is pathognomonic for anti-GBM. The presence of antimyeloperoxidase antibodies is described in the cases of anti-GBM and the presence of glomerular basement membrane antibody has a sensitivity of 95% but in the present case the initial dosage was negative. We did not find in the literature association of Rheumatoid Arthritis with Goodpasture´s Syndrome. After immunosuppression, the patient evolved with reversion of hemoptysis and improvement of renal function.