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Discussion Starter · #1 ·
A 60 year old male presented with cough, progressive breathlessness and hemoptysis. He is a current smoker, and worked as a mechanic. His mother had been treated for pulmonary TB a few years ago. Urinalysis shows blood +++, protein ++, numerous red cell casts. CXR was done (see below).

cxr231.jpg
click image to enlarge

This is his lung function-

FEV1 65% predicted
FVC 60% predicted
TLC 68% predicted
RV 66% predicted
TLCO 110% predicted

What is the management plan?

A. Steroid, brochodilators
B. Early plasmapharesis, methyprednisolone, cyclophosphamide
C. Anti-TB drug
D. Antibiotics for bacterial chest infection
E. Diuretics
 

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I second sinsinati - the renal findings suggest acute GN, this on backdrop of history alone suggests goodpasture - one should urgently intervene (B) to prevent development of RPGN
 

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Discussion Starter · #4 ·
Absolutely! Goodpasture's syndrome. Answer is B.
 
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