Goodpasture syndrome is a rare autoimmune disorder characterized by pulmonary hemorrhage and glomerulonephritis, due to formation of auto-antibodies against type 4 collagen protein.In it’s typically form pulmonary haemorrhage presents before, and more often the initial presentation, before the onset of end-stage renal disease (ESRD) secondary to Chronic GN. The development of pulmonary hemorrhage after progression to ESRD is an uncommon and unique phenomenon as represented in this case study. This is a case of 20-year-old unmarried female from Narowal, a known case of ESRD secondary to chronic glomerulonephritis, who presented with a three-day history of progressive dyspnea (NYHA Class III) and left-sided chest pain, along with light headedness and palpitations. Systemic inquiry revealed malaise, low-grade fever, and anorexia. There was no significant family history; she belonged to a low income house hold. Lastly there she had no known allergies, with no significant travel history and history of completed childhood vaccination. This case represents the peculiarity with the atypical presentation of pulmonary Hemorrhage after the progression to ESRD in Goodpasture syndrome, it is a rare and underreported occurrence. This finding shows the importance of prompt recognition and multidisciplinary management cases complex as these. This report contributes to the growing understanding of Goodpasture syndrome's varied clinical course and outcomes in ESRD patients.