Rapidly progressive anti-GBM disease secondary to long-standing rheumatoid arthritis: a case report and literature review

TL;DR

A rare case of anti-GBM disease in a long-term rheumatoid arthritis patient is reported, emphasizing the need for early diagnosis and careful treatment.

Contribution

The paper presents a rare case of anti-GBM disease in RA and reviews only ten previously reported cases, highlighting its rarity.

Findings

Anti-GBM disease occurred in a patient with long-standing RA without drug triggers.

Despite treatment, the patient remained dialysis-dependent and died from complications.

Only ten cases of RA with anti-GBM disease have been reported in the literature.

Abstract

Long-standing rheumatoid arthritis (RA) complicated by anti–glomerular basement membrane (anti-GBM) disease is exceptionally rare.

A 71-year-old man with long-standing seropositive RA developed a rapidly progressive glomerulonephritis due to anti-GBM disease, without any known drug triggers. Despite plasmapheresis (therapeutic plasma exchange), corticosteroids, and low-dose cyclophosphamide, he remained dialysis-dependent; RA activity was subsequently controlled with tocilizumab. Complications included Stenotrophomonas maltophilia pneumonia, COVID-19 and cytomegalovirus infection, and he died of pneumonia eight months after diagnosis.

This case highlights the need for early serological testing for anti-GBM disease in RA patients with unexplained hematuria/proteinuria and for immunosuppressive therapy mindful of infection risk. Additionally, our literature review identified only ten reported cases of RA with anti-GBM disease, highlighting the rarity of this condition.

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