A 44-year-old man with hematuria and hemoptysis most strongly suggests which syndrome?

• A. Goodpasture syndrome
• B. Granulomatosis with polyangiitis
• C. Churg-Strauss
• D. Microscopic polyangiitis

Answer: (A)

Hemoptysis with hematuria reflects autoimmune injury affecting both the lungs and kidneys. Goodpasture syndrome arises from anti-GBM antibodies that attack basement membranes in these two organs, causing pulmonary hemorrhage and rapidly progressive glomerulonephritis. This direct, dual-target mechanism makes this combination the strongest clue. Clinically, you’d expect anti-GBM antibodies in the blood and linear IgG deposition along the basement membranes on kidney biopsy, with urgent therapy using plasmapheresis and immunosuppression. While other vasculitides can involve both systems, their patterns (such as granulomatous features in GPA or eosinophilia and asthma in EGPA) and serologies are different, making Goodpasture the best fit for this presentation.