No abstract

Goodpasture's disease is associated with circulating anti-glomerular basement membrane (anti-GBM) antibodies. Thrombotic thrombocytopenic purpura (TTP) is a disease related to platelet clumping and microthrombosis in the circulation. We report an unusual case where both entities coexist in the same patient. The patient was a 43-year-old Caucasian male, with a recent history of inhalational hydrocarbon exposure for ~10 weeks. He initially presented with confusion, persistent fever and acute oliguric renal failure. In addition, he was found to be thrombocytopenic and had concurrent microangiopathic haemolytic anaemia. All presenting signs, symptoms and laboratory findings had a temporal relationship within 3 weeks. In addition, he was also found to have active pulmonary hemorrhage and positive anti-GBM antibody. During his stay, the patient underwent treatment with plasmapheresis, and an open lung biopsy, which confirmed the diagnosis of anti-GBM disease. This case report confirms previously reported findings which were noted in a few sporadic case reports about the possible association between Goodpasture's disease and TTP. In addition, it adds to our current understanding of the pathophysiology of autoimmune diseases in general and supports the theory of an autoimmune mosaic, which has also been noted in various other autoimmune diseases.

PURPOSE: The Advisory Committee on Immunization Practices (ACIP) recommended routine use of pneumococcal conjugate vaccine (PCV13) for adults age 19 through 64 years with immunocompromised conditions, functional or anatomic asplenia, cerebrospinal fluid (CSF) leaks, or cochlear implants and all adults aged 65 years or older. PCV13 should be administered to all eligible adults in addition to the pneumococcal polysaccharide vaccine (PPSV23) 1. We think that the PCV13 is still underutilized by general practitioners as well as other medical sub-specialty physicians including pulmonologists. We conducted this study as quality improvement project to estimate the number of inpatients who could potentially benefit from the PCV13 vaccine. METHODS: This was a single tertiary center admission data review, the sample of patients reviewed were over the period of time