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Anti-α 1(IV) Collagen Autoantibodies Associated with Lung Adenocarcinoma Presenting as the Goodpasture Syndrome
- Raghu Kalluri, PhD;
- Savas Petrides, MD;
- Curtis B. Wilson, MD;
- John E. Tomaszewski, MD;
- Harold I. Palevsky, MD;
- Michael A. Grippi, MD;
- Michael P. Madaio, MD; and
- Eric G. Neilson, MD
- From the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; and The Scripps Research Institute, La Jolla, California. Acknowledgments: The authors thank Marilyn Salcheider for technical assistance; Michael Rosen, MD, for referring the patient to the Hospital of University of Pennsylvania; and Dr. Billy G. Hudson for providing the Goodpasture antibodies. Grant Support: In part by National Institutes of Health grants DK-07006, DK-30280, DK-45191, and DK-20043 and the DCI RED fund. Requests for Reprints: Eric G. Neilson, MD, 700 Clinical Research Building, Penn Center for Molecular Studies of Kidney Diseases, Renal Electrolyte and Hypertension Division, University of Pennsylvania, 422 Curie Boulevard, Philadelphia, PA 19104-6144. Current Author Addresses: Drs. Kalluri, Petrides, Madaio, and Neilson: 700 Clinical Research Building, Renal Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, 422 Curie Boulevard, Philadelphia, PA 19104-6144. Dr. Wilson: Department of Immunology, The Scripps Research Institute, 10666 North Torrey Pines Road, La Jolla, CA 92037. Dr. Tomaszewski: Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104.
We report a case of adenocarcinoma of the lung with hemoptysis that was mistaken for the Goodpasture syndrome on the basis of a serologic test for antiglomerular basement membrane antibodies. Antiglomerular basement membrane antibodies are characteristic of the Goodpasture syndrome, some forms of rapidly progressive glomerulonephritis, and isolated instances of pulmonary hemorrhage. Antiglomerular basement membrane antibodies from patients with traditional Goodpasture syndrome react with the α 3(IV) chain, one of the six known chains of type IV collagen that form an integrative lattice called basement membrane [1, 2]. Evaluation of the antiglomerular basement membrane antibodies in our patient showed the presence of anti-α 1(IV) rather than anti-α 3(IV) reactivity.
Case History
A 72-year-old man (AG) presented with recurrent hemoptysis and abnormal chest radiograph. His work-up had previously been thought to be negative with the exception of an elevated titer for antiglomerular basement membrane antibodies. His medical history was remarkable for obstructive pulmonary disease, previously treated tuberculosis, and a 90 pack-year history of cigarette smoking. Physical examination on admission showed mild respiratory distress. Laboratory findings included a hemoglobin level of 107 g/L, a serum creatinine level of 70.72 µmol/L, and an erythrocyte sedimentation rate …
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