Top Differential Diagnosis Should Be Microscopic Polyangiitis in ANCA-Positive Patient with Diffuse Pulmonary Hemorrhage and Hemosiderosis

Figure 2

Goodpasture’s syndrome in a 26-year-old woman. The patient presented with rapid progressive dyspnea over 2 weeks. Twice bronchoalveolar lavages showed hemosiderin-laden macrophages in the cytology specimens. Later she was found to have positive serum level for antiglomerular basement membrane antibody, although her renal function was not obviously compromised. The patient expired despite intensive care. Microscopically, there was diffuse alveolar hemorrhage and hemosiderosis in the bilateral lung sections at the autopsy (panel (a), ×100, and panel (b), ×400). The hemosiderosis was confirmed by diffuse positive iron staining in hemosiderin-laden macrophages in panel (c) ((c), ×400). In panel (d), glomeruli were positive for linear IgG staining on immunofluorescent section, confirming antiglomerular basement membrane disease ((d), ×400), but no crescent formation was identified in the glomeruli. Overall autopsy findings were consistent with Goodpasture’s syndrome with dominant pathologic changes in her lungs.

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