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).