In this setting, patients have a worse prognosis than ANCA isolated conditions, with a clinical course more similar to pure anti-GBM disease.
Anti-GBM disease has similar features on light microscopy, with the addition of positive linear basement membrane staining with IgG in the glomeruli.
Anti-GBM disease is a diagnosis that is made when there is a presence of circulating anti-GBM antibodies in the serum.
Seronegative anti-GBM disease has been previously described and mostly blamed for the relative insensitivity of earlier serologic assays.
Here we present a case of seronegative anti-GBM disease with a positive p-ANCA serology.
There was bright linear glomerular basement membrane staining with IgG consistent with anti-GBM disease (Fig 2).
The prognosis in mixed ANCA and anti-GBM disease is similar to that of pure anti-GBM disease.
In anti-GBM disease, the likelihood of renal recovery correlates with the serum creatinine and need of dialysis at initial presentation.
Cases of isolated pulmonary involvement and seronegative anti-GBM disease were described previously.
The treatment of anti-GBM disease focuses on a combination of plasma exchange, cyclophosphamide, and prednisone.