Recurrent Goodpasture's disease due to a monoclonal IgA-kappa circulating antibody

We describe the case of a 54-year-old man who first presented with a clinic al syndrome manifested by recurrent pulmonary hemorrhage, hematuria, and mi ld renal insufficiency, Direct immunofluorescence of renal biopsy sections showed linear deposition of IgA-kappa in the glomerular (GBM) and tubular b asement membranes, Serum protein immunoelectrophoresis was positive for a m onoclonal immunoglobulin A (IgA)-kappa protein, Serum analysis showed circu lating IgA anti-GBM antibodies, Treatment with high-dose steroids, cyclopho sphamide, and plasma exchange resulted in resolution of the clinical pictur e, To the best of our knowledge, this is the first report of Goodpasture's disease associated with the presence of a circulating monoclonal IgA-kappa antibody. (C) 1999 by the National Kidney Foundation, Inc.