A 19–year–old man with severe obstructive lung disease

A 19-year-old boy presented to ambulatory clinic with shortness of breath after walking two blocks. He denied any cough, orthopnea, chest pain or hemoptysis. Ten months prior to admission he was admitted to the medical intensive care unit with respiratory failure and was diagnosed with Goodpasture syndrome. He was treated with cyclophosphamide and steroids. He was discharged home after recovering. Patient subsequently developed dyspnea on minimal exertion. Spirometry showed severe obstructive lung disease and HRCT of chest showed diffuse micronodular disease with patchy ground-glass opacities, mild bronchiectasis and bronchiolectasis. Serologies for goodpasture syndrome were normal. A diagnosis of post-Goodpasture syndrome constrictive bronchiolitis was made. Due to severity of symptoms he was treated with azithromycin. His FEV1 doubled in 3 months and in addition to significant clinical improvement the HRCT findings also improved. This is the first described case of constrictive bronciolitis developing as an aftermath of Goodpasture syndrome.