Differential Diagnosis of Goodpasture's Syndrome

Condition

Features

Goodpasture's disease

antibodies to glomerular basement membrane (anti-GBM), some may show p-ANCA; proteinuria rarely massive

Wegener's granulomatosis

p-ANCA and c-ANCA positive, granulomatous vasculitis, necrotizing nasal and oral inflammation, chest X-ray shows nodules, cavities or fixed infiltrates

microscopic polyangiitis

p-ANCA positive, systemic necrotizing vasculitis

systemic lupus erythematosus (SLE)

antinuclear antibodies (ANA), cutaneous, joint and systemic manifestations

Churg-Strauss syndrome

asthma, eosinophilia, perivascular eosinophil infiltrate, paranasal sinus disease

Henoch-Schonlein purpura

palpable purpura, arthritis, abdominal pain with acute GI hemorrhage

TTP or HUS

microangiopathic hemolytic disease

Behcet's disease

oral and genital aphthous ulcers, uveitis and skin lesions

essential mixed IgG/IgM cryoglobulinemia

cryoglobulins

hypersensitivity reaction during D-penicillamine therapy

history of D-penicillamine therapy

rheumatoid vasculitis

Rheumatoid factor (RF)

end-stage renal disease with congestive heart failure

history of renal disease, signs of congestive heart failure

Legionella pneumonia

pneumonia with renal failure

nephrotic syndrome with hypercoagulable state causing pulmonary embolism and renal arterial thrombosis

nephrotic level proteinuria; decreased protein C, protein S levels or antithrombin III; evidence of amyloidosis