Figure 2. CT of the chest showing Bilateral diffuse consolidation with
centrilobular nodules, in keeping with alveolar space disease
The patient was started on pulse steroids, and an anti-glomerular
basement membrane antibodies test was sent. On 19th August 2021,
echocardiography was done and reported as normal, followed by an
ultrasound-guided kidney biopsy on the same day.
Although the patient was started on steroids, he continued to
deteriorate. His oxygen requirement increased, Renal parameters
worsened, and he developed lower limb edema, followed by decreased urine
output. At this point, the patient was shifted to the intensive care
unit, central line inserted and the nephrology team started him on
regular hemodialysis. On 20th August, the report of anti-GBM antibody
was released. It was positive (titter = 550.0 U/mL). Plasmapheresis
started and planned to be continuous with weekly measuring the antibody
titter till it becomes negative. In addition to that, the patient was
started on Cyclophosphamide 100 mg daily, and the plan was to continue
for a total of three months. On 23rd August, the biopsy result was
reported as Crescentic glomerulonephritis, consistent with Anti-GBM
disease (Figure 3).