Hydralazine-Induced Anca-Associated Vasculitis: A Rare Cause of Diffuse Alveolar Hemorrhage

Mulkareddy, V.; Bhalla, Vinod K.; Mangla, Ankit

doi:10.1016/j.chest.2020.05.408

Cited by 2 publications

(6 citation statements)

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“…Serologic features of hydralazine‐associated DIL and AAV overlap, supporting the claim that these immunologic processes may represent a spectrum of the same disease 7 . Studies of simultaneous DIL and AAV caused by hydralazine have been reported.…”

Section: Discussionmentioning

confidence: 72%

“…Our patient presented with a clinical finding of diffuse alveolar hemorrhage, a rare but life‐threatening presentation of hydralazine‐induced AAV 7,18 . Although there were no overt clinical signs of DIL other than fever, she had a positive serologic profile for DIL, including positive anti‐Smith, anti‐cardiolipin IgM, anti‐dsDNA antibodies, and low C3 complement levels.…”

Section: Discussionmentioning

confidence: 83%

“…Serologic features of hydralazine-associated DIL and AAV overlap, supporting the claim that these immunologic processes may represent a spectrum of the same disease. 7 Studies of simultaneous DIL and AAV caused by hydralazine have been reported. Padala et al 16 reported a case of dual DIL and AAV in a patient taking hydralazine 100 mg every 8 h for over 5 years.…”

Section: Discussionmentioning

confidence: 99%

“…Based on the clinical, serologic testing, and biopsy results, our findings were consistent with DIV with overlapping AAV and DIL nephritis secondary to hydralazine use. Coxsackievirus infection can cause pulmonary hemorrhage but cannot explain the positive serology 7 . Hydralazine was immediately discontinued, and treatment was started with a high‐dose corticosteroid taper, 1.5 mg/kg cyclophosphamide for 14 days, and plasmapheresis.…”

Section: Case Presentationmentioning

confidence: 99%

“…Coxsackievirus infection can cause pulmonary hemorrhage but cannot explain the positive serology. 7 Hydralazine was immediately discontinued, and treatment was started with a high-dose corticosteroid taper, 1.5 mg/kg cyclophosphamide for 14 days, and plasmapheresis. Despite such a complex disease presentation, our patient survived but required ongoing hemodialysis.…”

Section: A S E Pr E S E Ntati O Nmentioning

confidence: 99%

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Overlapping drug‐induced vasculitis, ANCA‐associated vasculitis, and lupus nephritis caused by low‐dose hydralazine

Bhatnagar,

Agaronov,

Sarkisyan

et al. 2023

Int J of Rheum Dis

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IntroductionWe present a case of drug‐induced vasculitis secondary to low‐dose hydralazine with overlapping features of antineutrophil cytoplasmic antibody‐associated vasculitis and drug‐induced lupus nephritis.Case presentationA 52‐year‐old Hispanic woman with a medical history of resistant hypertension treated with hydralazine 10 mg twice daily for 1 year presented with generalized weakness, dizziness, nausea, vomiting, and gross hematuria. There was fever, tachycardia, leukocytosis, lactic acidosis, hyperkalemia, renal failure, and anemia. Chest computed tomography and bronchoscopy revealed a left lower lobe infiltrate and diffuse alveolar hemorrhage. Serologic testing was positive for anti‐double‐stranded DNA, anti‐Smith, lupus anticoagulant, anti‐histone, anti‐cardiolipin IgM antibodies, and antineutrophil cytoplasmic antibodies (myeloperoxidase and proteinase 3). A kidney biopsy revealed crescentic glomerulonephritis with an overlapping finding of membranous nephropathy. Broad‐spectrum antibiotics, immunosuppressants, corticosteroids, and plasmapheresis were initiated. The patient survived but required continuous hemodialysis.ConclusionsAlthough a few cases of simultaneous antibody‐associated vasculitis and drug‐induced lupus nephritis secondary to hydralazine use have been reported, this case is singular. Similar findings were previously reported with doses of 50–100 mg two to three times daily over 1–5 years. In our patient, a dose of only 10 mg twice daily for a year caused a severe disease presentation. This brings to light the combination of different vasculitides that can coexist and the potentially life‐threatening adverse effects of low‐dose hydralazine that should be kept in mind.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 83%