Goodpasture's syndrome with negative serology

Goodpasture's syndrome, the syndromic manifestation of antiglomerular basement membrane (anti-GBM) disease, is an uncommon autoimmune phenomenon that typically presents with lung and renal pathology. The classic patient is young with few comorbidities and typically presents dramatically with diffuse alveolar hemorrhage and/or rapid unexplained kidney failure following respiratory infection. Serological tests are traditionally helpful in establishing the diagnosis, but rare cases of anti-GBM disease may be negative for associated serological markers, namely anti-GBM antibody. This case illustrates the classic clinical features of the pulmonary manifestations of anti-GBM disease with negative serological markers confirmed by immunofluorescence of alveolar basement membrane sampled at autopsy.