Atypical presentation of anti-glomerular basement membrane disease. Pediatric Case

We describe the clinical case of a 13-year-old girl diagnosed with anti-glomerular basement membrane disease and central nervous system involvement. The patient presented with a generalized tonic‒clonic seizure as the first clinical finding secondary to an intraparenchymal hemorrhage and cerebral vasculitis. Acute renal injury was also detected without the need for renal replacement therapy, hematuria, arterial hypertension, significant proteinuria, and pulmonary hemorrhage with diffuse ground‒glass alveolar infiltrate. The diagnosis was established through renal biopsy, which revealed a pattern of extracapillary glomerulonephritis with linear deposition of IgG and the presence of anti-GBM antibodies in the plasma. In our case, the patient was treated with pulses of corticosteroids, cyclophosphamide, and plasmapheresis. She evolved with normalization of renal function, albuminuria, and no neurological sequelae on imaging. Anti-glomerular basement membrane disease is a vasculitis of small vessels that affects the kidneys (90%) and lungs (60%) and is the cause of 1–2% of acute glomerulonephritis and 10–15% of rapidly progressive glomerulonephritis.