A Suspected Case of Hydralazine-Induced Hepatotoxicity: A Case Report and Review of Literature

Abstract

Patient: Male, 74Final Diagnosis: Hydralazine induced hepatotoxicitySymptoms: Abdominal discomfortMedication: HydralazineClinical Procedure: —Specialty: CardiologyObjective:Rare diseaseBackground:Hydralazine is an effective antihypertensive agent but may rarely have devastating hepatotoxic effects that are extremely variable, thus making the diagnosis difficult.Case Report:We report the case of a 74-year-old male patient who had transaminitis after being started on hydralazine by his cardiologist for poorly controlled hypertension. He had extreme dizziness, nausea, and weakness, which all resolved after discontinuation of hydralazine, and liver function test results also dramatically improved.Conclusions:It is imperative that clinicians be aware of the possible hepatotoxicity of hydralazine and its clinical features so that the medication can be promptly discontinued to help promote liver recovery. This case report will add to the current literature about such infrequent cases of hydralazine-induced hepatotoxicity.

Hydralazine-induced liver injury: a review and discussion

“…Although the symptomology remains similar between both clinical patterns, biopsy of the liver in the longer latency form shows chronic hepatitis and fibrosis14 and has been associated with liver microsomal antibody detection 2. The recovery during this time is often prolonged, and such cases have also been found to be more likely associated with lupus-like syndrome 14 16. Our patient’s liver injury resembled the first clinical pattern, involving a short latency period with rapid recovery of symptoms following discontinuation of the drug.…”

Managing Multiple Myeloma in the Face of Drug-Induced Adverse Drug Reaction

“…Many of the medications the patient was receiving have been documented to cause increased liver enzymes including amlodipine, baclofen, dabigatran, hydralazine, labetalol, and pantoprazole. [12][13][14][15][16][17][18][19][20] As noted in Table 1, the patient was taking baclofen, dabigatran, and labetalol at home prior to admission. The baclofen was discontinued 6 days prior to the rise in liver enzymes.…”

Diffuse Alveolar Hemorrhage Secondary to Hydralazine-Induced Antineutrophilic Cytoplasmic Antibody–Associated Vasculitis

“…It is a phthalazine derivative, which was first introduced in 1951. 1,2 Hydralazine is generally safe with commonly reported side effects, including headache, tachycardia, and palpitations, and less commonly reported side effects being flushing, nausea, vomiting, and edema. 1 Hydralazine has also been associated with 2 drug-induced autoimmune conditions-druginduced lupus and, rarely, drug-induced antineutrophilic cytoplasmic antibodies (ANCA)-associated vasculitis.…”