Anti-glomerular basement membrane disease in an HIV-infected patient

Autoantibody production is common in HIV-infected individuals. In this Case Study, Wechsler and colleagues describe a case of anti-glomerular basement membrane disease in a 55-year-old HIV-positive male. Treatment with steroids, intravenous immunoglobulin, mycophenolate mofetil and rituximab resulted in improved renal function and disappearance of the autoantibodies. Background A 55-year-old HIV-positive male presented with gross hematuria, proteinuria, acute azotemia, and recurrent left hip septic arthritis. Anti-glomerular basement membrane (anti-GBM) antibodies were present in the patient's serum, and eosinophils were noted in his urine. Renal biopsy revealed active crescents, with linear staining of the capillary wall for IgG consistent with anti-GBM nephritis. Investigations Physical examination, blood and urine analyses, chest X-ray, CT imaging of the abdomen and pelvis, renal ultrasound, and renal biopsy. Diagnosis Anti-GBM disease. Management Owing to the presence of active HIV infection and recurrent left hip septic arthritis, a novel approach to treatment was pursued in the hope of reducing infectious consequences. The patient received steroids, intravenous immunoglobulin, rituximab, and mycophenolate mofetil.