Treatment of dual-positive anti-glomerular basement membrane and ANCA disease using rituximab in addition to plasma exchange, corticosteroids and cyclophosphamide

We present the case of a transgender man with dual-positive anti-glomerular basement membrane and anti-neutrophil cytoplasm antibody disease who was able to achieve dialysis independence with sustained disease remission and renal recovery. This was achieved using a treatment regimen of plasma exchange, high-dose corticosteroids, cyclophosphamide and rituximab. Despite a number of poor prognostic factors, including requirement for dialysis during the index admission and a high proportion of crescents on diagnostic biopsy, the patient was able to achieve renal recovery. This case report adds to the limited literature supporting the use of rituximab as part of the treatment regimen of dual-positive disease.