Severe acute respiratory failure (SARF) secondary to concurrent pulmonary-only anti-GBM syndrome and thrombo-embolic disease

Severe acute respiratory failure (SARF) secondary to concurrent pulmonary-only anti-GBM syndrome and thrombo-embolic disease

Published: 23 Jan 2017

© Anaesthesia Cases / 2017-0004 / ISSN 2396-8397

Authors

Dr Matthew Charlton [1]
Dr Ricky Bell [2]
Dr Hakeem Yusuff [3]
Dr Rakesh Vaja [3]
  • [1] Clinical Lecturer, Adult Intensive Care, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
  • [2] Specialist Registrar, Adult Intensive Care, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
  • [3] Consultant, Adult Intensive Care, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom

Summary

We report the case of a 20-year-old male patient presenting to the Emergency Department with severe type 1 respiratory failure due to diffuse alveolar haemorrhage secondary to pulmonary-only anti-glomerular basement membrane (anti-GBM) disease, a rare presentation of this reno-pulmonary syndrome.  The patient had developed multiple pulmonary venous emboli and an intra-cerebral arterial thrombus. There are limited reports of pulmonary emboli coinciding with anti-GBM disease and no other reports of concomitant arterial thrombus. We describe the presentation and consider the management of this rare, serious cause of hypoxaemia and the possible role of extra-corporeal membrane oxygenation in this patient group.  We review the pathophysiology of anti-GBM disease and the reported cases of accompanying venous or arterial thrombo-emboli in related conditions.

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