TY - JOUR T1 - Coexistent Wegener’s Granulomatosis and Goodpasture’s Disease JF - The Journal of Rheumatology JO - J Rheumatol SP - 1786 LP - 1787 DO - 10.3899/jrheum.091404 VL - 37 IS - 8 AU - SUNITA MULPURU AU - CLAIRE TOUCHIE AU - JOLANTA KARPINSKI AU - SUSAN HUMPHREY-MURTO Y1 - 2010/08/01 UR - http://www.jrheum.org/content/37/8/1786.abstract N2 - To the Editor:Wegener’s granulomatosis (WG) and Goodpasture’s disease are unique etiologies of pulmonary-renal syndromes. Given the similarity in clinical presentation, differentiating these diseases at the bedside can be challenging.A 50-year-old woman was referred to the rheumatology clinic with a presumptive diagnosis of vasculitis. She presented with a 12-month history of recurrent epistaxis, nasal crusting, migratory arthralgias, and a 20-pound weight loss. She was also diagnosed and treated for an isolated episode of scleritis in the left eye. In the week prior to presentation, she developed sores on her tongue, mild dyspnea, and new onset hemoptysis.Examination was remarkable for tongue ulcerations, nasal mucosal ulcerations, and splinter hemorrhages. Other findings included palpable purpura of the lower extremities, 3 joint effusions (both knees, left ankle), and 7 tender joints. Chest examination revealed fine crackles at bases; cardiovascular examination was normal.Laboratory investigations revealed an elevated erythrocyte sedimentation rate of 60 mm/h, and urinalysis with 3+ blood and trace protein. Creatinine at presentation was 77 μmol/l. The cytoplasmic antineutrophil antibody (c-ANCA) was positive [proteinase-3 (PR-3)-positive, myeloperoxidase-negative] as was the anti-glomerular basement membrane (anti-GBM) antibody.Chest radiograph revealed symmetric interstitial and airspace changes consistent with differential diagnosis of pulmonary hemorrhage, atypical infection, or acute noncardiogenic pulmonary edema. She underwent a computed tomography scan of the thorax, which demonstrated ground-glass opacity in keeping with pulmonary hemorrhage (Figure 1), while skin biopsy of her palpable purpura revealed a leukocytoclastic vasculitis.Figure 1. Computed … Address correspondence to Dr. S. Mulpuru, The Ottawa Hospital, University of Ottawa, Department of Medicine, 501 Smyth Road, Room 6356, Box 211, Ottawa, Ontario K1H 8L6. E-mail: sunitamulpuru{at}hotmail.com ER -