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Alveolar haemorrhage in anti-glomerular basement membrane disease without detectable antibodies by conventional assays
  1. D J Serisier1,
  2. R C W Wong2,
  3. J G Armstrong3
  1. 1Department of Respiratory Medicine, Mater Adult Hospital, South Brisbane, Queensland 4101, Australia
  2. 2Queensland Health Pathology Service, Princess Alexandra Hospital, Woolloongabba, Queensland 4102, Australia
  3. 3Respiratory Medicine Department, Princess Alexandra Hospital, Woolloongabba, Queensland 4102, Australia
  1. Correspondence to:
    Dr D J Serisier
    Department of Respiratory Medicine, Mater Adult Hospital, Raymond Tce, South Brisbane, Queensland 4101, Australia; david_serisier{at}mater.org.au

Abstract

Anti-glomerular basement membrane (anti-GBM) disease represents the spectrum of disease attributable to circulating anti-GBM antibodies. While active anti-GBM disease in the absence of circulating anti-GBM antibodies has been described, it is considered rare with the use of current routinely available assays. We report four subjects with features consistent with active anti-GBM antibody disease without detectable antibodies by routinely available enzyme linked immunosorbent assay (ELISA) and immunoblot techniques. All were smokers who presented with diffuse alveolar haemorrhage, minimal renal involvement, and undetectable anti-GBM antibodies. Seronegative anti-GBM disease with predominant pulmonary involvement may be more common than previously appreciated and should be part of the differential diagnosis for otherwise unexplained diffuse alveolar haemorrhage. Renal biopsy with immunofluorescent studies should be considered in the diagnostic evaluation of such subjects, including those with idiopathic pulmonary haemosiderosis.

  • ANCA, anti-neutrophil cytoplasmic antibodies
  • GBM, glomerular basement membrane
  • IIF, indirect immunofluorescent
  • Kco, carbon monoxide transfer factor
  • RIA, radioimmunoassay
  • anti-glomerular basement membrane disease
  • alveolar haemorrhage

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