Inaugural cardiac involvement in Goodpasture syndrome: a case report

BACKGROUND: Goodpasture syndrome is a rare autoimmune disease classically revealed by diffuse alveolar hemorrhage and rapidly progressive glomerulonephritis. Inaugural cardiac involvement is exceptionally rare. CASE PRESENTATION: We report the case of a 44-year-old North African origin (Tunisian) female patient without any known cardiovascular risk factors, presented with an acute coronary syndrome without ST-segment elevation (NSTEMI) with elevated troponin. Cardiac MRI has showed transmural myocardial necrosis. Days later, massive hemoptysis, acute respiratory distress syndrome, and acute kidney injury revealed an underlying anti-glomerular basement membrane (anti-GBM) disease (Goodpasture syndrome), confirmed by positive anti-GBM antibodies. Despite high-dose intravenous corticotherapy and plasmapheresis, the patient died. CONCLUSIONS: This case illustrates an unusual presentation of Goodpasture syndrome beginning with ischemic cardiac involvement, and highlights the value of cardiac MRI for differential diagnosis and management of acute coronary syndromes in young patients.