A 35-year-old man presents with haemoptysis and rapidly progressive glomerulonephritis. Creatinine is 4.8 mg/dL. Anti-GBM antibody is positive. ANCA is also positive. Renal biopsy shows >90% crescents. Lungs show diffuse alveolar haemorrhage on bronchoscopy. What is the treatment of choice?
- A Rituximab alone
- B Plasma exchange plus cyclophosphamide and corticosteroids ✓
- C Corticosteroids alone with close monitoring
- D IV methylprednisolone pulse without plasma exchange
Correct answer: B. Plasma exchange plus cyclophosphamide and corticosteroids
Explanation
Anti-GBM disease (Goodpasture's syndrome) with diffuse alveolar haemorrhage requires urgent plasma exchange (plasmapheresis) to rapidly remove circulating anti-GBM antibodies, combined with immunosuppression (cyclophosphamide + high-dose corticosteroids) to prevent new antibody production. Plasma exchange is uniquely important in anti-GBM disease because antibody removal is critical; it is not routinely indicated in ANCA vasculitis without anti-GBM. Double positivity (anti-GBM + ANCA) carries the worst prognosis and requires the most aggressive treatment.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.