Hindawi Publishing Corporation Case Reports in Medicine Volume 2010, Article ID 426970, 6 pages doi:10.1155/2010/426970 Case Report Goodpasture’s Syndrome and Silica: A Case Report and Literature Review James Dahlgren,1 Marla Wardenburg,2 and Trevor Peckham2 1 UCLA School of Medicine-Occupational Medicine, 2811 Wilshire Boulevard, Suite 510, Santa Monica, CA 90403, USA 2 James Dahlgren Medical, 2811 Wilshire Boulevard, Suite 510, Santa Monica, CA 90403, USA Correspondence should be addressed to Trevor Peckham, trevor@envirotoxicology.com Received 31 March 2010; Revised 15 July 2010; Accepted 24 August 2010 Academic Editor: Roland M. du Bois Copyright © 2010 James Dahlgren et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We report a case of Goodpasture’s syndrome following chronic low level and an acute, high level of exposure to crystalline silica. A 38-year-old male tilesetter was admitted to the emergency room with dyspnea and respiratory failure. He reported that his symptoms had developed over the previous week after inhaling a large amount of dust while dry-sanding and sweeping a silica-based product used to ﬁll cracks in a cement ﬂoor. Over the following days, his pulmonary function declined and he developed acute renal failure. Tests of antiglomerular basement membrane antibody were positive and renal biopsy revealed global glomerulonephritis. He was diagnosed with Goodpasture’s syndrome and treated with steroids, plasmapheresis, and hemodialysis. This man had a history of childhood asthma and a remote, one pack-year history of cigarette use. He used the ﬂooring product for seven years prior to the inciting event, however, previous jobs had utilized signiﬁcantly smaller amounts. Goodpasture’s syndrome and other autoimmune diseases have been reported in association with silica exposure. The acute onset following high level silica exposure in this previously healthy man, suggest that clinicians should investigate silica exposure as a causal factor in cases of Goodpasture’s syndrome. 1. Introduction Goodpasture’s Syndrome is a rare autoimmune disease char- acterized by pulmonary hemorrhage and glomerulonephri- tis. Clinical features of Goodpasture’s Syndrome include rapidly progressive renal failure and chest radiographs show localized or diﬀuse alveolar shadowing. Renal biopsy is needed to conﬁrm the diagnosis and reveals a crescentic glomerulonephritis and ﬁbrinoid necrosis. In addition, diag- nostic criteria include a positive anti-glomerular basement membrane (GBM) antibody. Treatment for Goodpasture’s Syndrome includes steroids, hemodialysis, and plasma- pheresis. Disease progression can be halted with medical intervention; however, renal and pulmonary damage can be permanent. Silica, also known as silicon dioxide, is a compound commonly found in nature and is widely used. Silica is a principal component in many products, including glass, concrete, ceramics, food additives, insulation, concrete con- struction, foundry castings, sandblasting, and paint, to name a few. Many workers in the US are at risk of occupational exposure to respirable crystalline silica, especially jobs in industries such as construction, abrasive blasting, foundry work, stonecutting, rock drilling, quarry work, and tunnel- ing. Occupational exposures to respirable crystalline silica are associated with the development of silicosis, a progressive ﬁbrosis in the lung. These exposures have also been known to cause autoimmune diseases such as scleroderma, rheumatoid arthritis, and glomerulonephritis [1]. Crystalline silica is classiﬁed as a Group 1 carcinogen by the International Agency for Research on Cancer. We describe here a 38- year-old man who developed Goodpasture’s Syndrome after chronic low level and an acute, high level exposure to crystalline silica. 2. Case Presentation A 38-year-old man presented to the emergency room complaining of cough, dyspnea, and bloody sputum. When