Hydralazine-associated antineutrophil cytoplasmic antibody vasculitis with pulmonary–renal syndrome

Abstract

Hydralazine, a vasodilator, is commonly used as an adjunctive treatment for moderate to severe hypertension, heart failure and hypertensive emergencies in pregnancy. Hydralazine-induced lupus was first described in 1953. Clinical presentation ranges from arthralgia, myalgia, petechiae, or rash to single or multiorgan involvement. An occurrence of systemic vasculitis is a rare complication. When presented as the pulmonary–renal syndrome, it could have a rapidly progressive course which can be fatal. Here, we describe a case of hydralazine-associated rapidly progressive glomerulonephritis and pulmonary haemorrhage. We use this case to review the current literature and discuss and highlight the importance of a high degree of clinical acumen, early diagnosis and prompt treatment for better clinical outcomes.

Hydralazine-induced antineutrophil cytoplasmic antibody-associated vasculitis with pulmonary–renal syndrome: a case report

“…Corticosteroids with cyclophosphamide or rituximab and therapeutic plasma exchange may be considered on an individual basis especially in cases associated with pulmonary-renal syndrome. It is important to warn the patient about the future use of the offending drug and include it in their adverse reaction list [6].…”

“…Early diagnosis of hydralazine-induced ANCA-associated vasculitis followed by discontinuation of the drug with prompt medical management will result in better clinical outcomes. To the best of our knowledge, there are 25 reported cases of hydralazine-induced ANCA-associated vasculitis with pulmonary-renal syndrome [6].…”

Kaposi sarcoma in anti-neutrophil cytoplasmic antibody-associated vasculitis: a case-based review

“…One of the unusual aspects of this case was the possibility of the manifestations of AAV being hydralazineinduced. Severe manifestations including pulmonary-renal syndrome have been described in hydralazine-induced vasculitis [7][8][9][10][11][12]. A clue to this entity is the serologic profile which often includes other antibodies often seen in systemic lupus erythematosus (which hydralazine can also induce) in addition to ANCA (usually p-ANCA, MPO) [12].…”

Hydralazine-induced pericardial effusion

“…2,7 Life-threatening complications like pericardial tamponade 10,11 and vasculitis can also occur but are less common. 12 Borchers et al proposed the following diagnostic criteria: (1) continuing exposure to a specific drug, (2) at least one symptom compatible with lupus, (3) no history of lupus or symptoms suggesting of lupus prior to starting the drug, and (4) resolution of symptoms after discontinuation of the agent. 2 ANA positivity (>90%) is common, but a negative ANA should not preclude the diagnosis, particularly if a patient has other autoantibodies associated with lupus/DIL.…”