An Unusual Case of Anti–Glomerular Basement Membrane Disease and PLA2R-Associated Membranous Nephropathy After Exposure to Hydrocarbons

We present a rare case of a patient with toluene exposure manifesting as anti-GBM disease on a background of PLA2R-associated membranous nephropathy. A 23-year-old man presented to the emergency department with hypertension, headache, hemoptysis, anemia, acute kidney injury, glomerular hematuria, and proteinuria. He endorsed repeated exposure to toluene-containing products while repairing dirt bikes. Serologies were positive for anti-GBM antibodies. Kidney biopsy showed crescentic glomerulonephritis with linear IgG and granular PLA2R staining by immunofluorescence.