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My route to a steroid psychosis

BMJ 1999; 318 doi: http://dx.doi.org/10.1136/bmj.318.7175.67 (Published 02 January 1999) Cite this as: BMJ 1999;318:67
  1. Simon Jenkins, general practitioner.
  1. Bury

    In November 1997a renal biopsy showed the pathognomic signs of Goodpasture's syndrome. Eight months earlier I had had a mysterious septicaemic illness for which no aetiological agent was ever found and from which I apparently recovered.

    However, over the ensuing months the antiglomerular basement membrane (anti-GBM) antibodies were silently accumulating until they reached levels that were off the measurable scale. By the time I presented to the renal unit at Manchester Royal Infirmary, my renal function was terminally compromised.

    The therapeutic plan adopted a three-fold approach. Firstly, switch off the antibody production using cyclophosphamide 150 mgs daily. Secondly, remove the existing antibodies by a process of immunoabsorption. The machines for this procedure are few and far between and rarely used. Goodpasture's syndrome is in itself a rare disease—only one person in a million develops it each year. The third part of the strategy was to protect my remaining nephrons from the dangerously high levels of …

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