An unusual case of a patient with Goodpasture's disease presenting wit
h hemoptysis, severe iron deficiency anemia and microscopic hematuria
and proteinuria is described. Both circulating and tissue anti-glomeru
lar basement membrane (GEM) antibodies were present, and renal functio
n remained normal throughout. Immunosuppressive therapy was given for
subclinical pulmonary hemorrhage with successful resolution of anemia
and disappearance of the circulating anti-GEM antibody. Nine months af
ter presentation he developed nephrotic range proteinuria and a repeat
renal biopsy revealed membranous glomerulonephritis with no evidence
of his original disease. Both the Goodpasture's associated HLA-DR2 and
the membranous associated HLA-DR3 class II antigens were present. The
association of antibody mediated and immune complex glomerulonephriti
s is discussed, The simultaneous presence of HLA-DR2 and HLA-DR3 may p
redispose to this association.