anti-glomerular basement membrane disease with thrombotic thrombocytopenic purpura

We report a 25-year-old man who was initially presented with rapidly progressive glomerulonephritis (rpgn) in shahid modarress hospital, tehran, iran. his diagnosis was anti-glomerular basement membrane (anti-gbm) disease that was confirmed by kidney biopsy, as his serum anti-gbm antibody was undetectable. although the patient was on cyclophosphamide and high dose prednisolone, he developed thrombotic thrombocytopenic purpura (ttp). we initiated treatment with a high dose of prednisone and plasmapheresis. because of his poor response, rituximab was administered. after that, the patient’s hematologic criteria and clinical symptoms improved to an acceptable level. our case is a unique form of negative serum anti-gbm antibody disease which was complicated with ttp and responded to treatment with rituximab.