Rapidly Progressive Anti-GBM Disease Secondary to Long-standing Rheumatoid Arthritis: A Case Report and Literature Review

Ji Li^1*Jing Zhang¹Sheng-Guang Li^1*Qian Guo^2,3Jing Xu^2,3Lina Zhang²Yadan Zou²Ting Long²Ruohan Yu²Yanfeng Zhang²

• ¹Department of Rheumatology and Immunology, Peking University International Hospital, Beijing, China
• ²Peking University International Hospital, Beijing, China
• ³Department of Rheumatology and Immunology, Peking University Shougang Hospital, Beijing, China

Background: Long-standing rheumatoid arthritis (RA) complicated by anti– glomerular basement membrane (anti-GBM) disease is exceptionally rare. Case: A 71-year-old man with long-standing seropositive RA developed a rapidly progressive glomerulonephritis due to anti-GBM disease, without any known drug triggers. Despite plasmapheresis (therapeutic plasma exchange), corticosteroids, and low-dose cyclophosphamide, he remained dialysis-dependent; RA activity was subsequently controlled with tocilizumab. Complications included Stenotrophomonas maltophilia pneumonia, COVID-19 and cytomegalovirus infection, and he died of pneumonia eight months after diagnosis. Conclusion: This case highlights the need for early serological testing for anti-GBM disease in RA patients with unexplained hematuria/proteinuria and for immunosuppressive therapy mindful of infection risk. Additionally, our literature review identified only ten reported cases of RA with anti-GBM disease, highlighting the rarity of this condition.