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Uveitis initiating an autoimmune reaction resulting in Goodpasture’s syndrome in a Chinese man
  1. M Chak1,
  2. M R Stanford1,
  3. W Poon1,
  4. E M Graham1,
  5. M F Tungekar2,
  6. D Goldsmith3
  1. 1Department of Ophthalmology, GKT, St Thomas’s Hospital, London, UK
  2. 2Department of Histopathology, GKT, St Thomas’s Hospital, London, UK
  3. 3Renal Unit, GKT, Guy’s Hospital, London, UK
  1. Correspondence to: Miss Melanie Chak, Centre for Paediatric Epidemiology and Department of Ophthalmology, Institute of Child Health, 30 Guildford Street, London WC1N 1EH, UK

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Goodpasture’s syndrome is an autoimmune disease caused by IgG directed against the alpha-3 chain of type IV collagen found in basement membrane. It causes pulmonary haemorrhage and renal failure. The antibody has been demonstrated in the basement membranes in the eye. However, ophthalmological complications in Goodpasture’s syndrome are rare. As with other autoimmune diseases, Goodpasture’s syndrome patients have a strong susceptibility based on a genetic background.1 Much evidence supports the concept that cross reactivity with exogenous epitopes or insult to the basement membrane can initiate the process of autoimmunity resulting in Goodpasture’s syndrome.1 We present a case of a Chinese man in whom we believe uveitis precipitated the autoimmune reaction causing Goodpasture’s syndrome

Case report

A 77 year old Chinese man from Hong Kong presented to the eye casualty department with a 1 month history of a black patch in the centre of his visual field in the left eye. Before this he noticed floaters and a “black cloud” in the left eye. He did not complain of pain or photophobia.

Three months earlier he had an episode of acute anterior uveitis, which resolved with dexamethasone and cyclopentolate drops. His vision at that episode was 6/24 in the right eye and 6/12 in the left eye. Six months earlier he had developed septicaemia secondary to a urinary tract infection treated with a course of intravenous flucloxacillin and fusidic acid and he made a good recovery.

He came to the United Kingdom 30 years ago and returned to Hong Kong for holidays every few years. There was no family history of note.

He looked well on examination and he was apyrexial. Systemic examination was unremarkable apart from an itchy rash on both his legs and his blood pressure was 104/60.

His visual acuity was 6/9, N6 in the right eye and …

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