Hydralazine Induced Lupus Syndrome Presenting with Recurrent Pericardial Effusion and a Negative Antinuclear Antibody

Iyer, Praneet; Dirweesh, Ahmed; Zijoo, Ritika

doi:10.1155/2017/5245904

Cited by 13 publications

(13 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…HILS should be suspected in any patient on hydralazine presenting with unexplained effusion; moreover, in our patient, additional laboratory evidence revealed the presence of active lupus, including low C3, elevated ESR and CRP, pancytopenia, negative anti-dsDNA, and positive anti-histone antibody ( 5 ). We believe the clinical picture and laboratory findings of our patient were consistent with the presentation of HILS with negative ANA ( 3 , 4 ).…”

Section: Introductionsupporting

confidence: 81%

See 1 more Smart Citation

Antinuclear antibody-negative lupus? An ominous presentation of hydralazine-induced lupus syndrome

et al. 2018

View full text Add to dashboard Cite

Up to 10% of systemic lupus erythematosus (SLE) cases are drug-induced; hence, they are called drug-induced lupus syndrome (DILS). Antinuclear antibody (ANA) should be present to diagnose SLE and DILS. ANA-negative lupus is very rare; therefore, it presents a diagnostic challenge. In the medical literature, two cases of ANA-negative hydralazine-induced lupus syndrome (HILS) have been described within the last year. Here, we present the third such case of HILS with negative ANA serology in a patient who developed considerable pericardial effusion. The association between ANA-negative HILS and pericardial effusion warrants future research.

show abstract

Section: Introductionsupporting

confidence: 81%

“…Positive antinuclear antibody (ANA) serology is the standard for SLE and DILS diagnosis. In the literature, only two cases so far have described an unusual presentation of HILS with negative ANA ( 3 , 4 ). In both these cases, patients presented with pericardial effusion.…”

Section: Introductionmentioning

confidence: 99%

Antinuclear antibody-negative lupus? An ominous presentation of hydralazine-induced lupus syndrome

et al. 2018

View full text Add to dashboard Cite

show abstract

“…One of its more infrequent presentations reported in medical literature is pericardial effusion reported at <5% [ 2 ]. As per our literature review, this is the second case of hydralazine causing DILE with a negative ANA [ 3 ].…”

Section: Introductionmentioning

confidence: 96%

ANA-Negative Hydralazine-Induced Pericardial Effusion

Zeitjian

Mehdizadeh

2017

Case Reports in Medicine

View full text Add to dashboard Cite

This case describes a patient with pericardial effusion as a phenomenon of the drug-induced lupus erythematosus (DILE) syndrome due to hydralazine. The relevance of this case report lies in the fact that although hydralazine has been a known causative agent of DILE, its presentation may involve a negative anti-nuclear antibody (ANA) study. Pericardial effusion is a documented adverse effect as a result of hydralazine use. It is typically common to screen for DILE with the serum ANA test prior to proceeding to more costly and specific tests (i.e., anti-histone antibody). As per our literature review, this is the second case of hydralazine causing DILE with a negative ANA. As in our case, although the screening serum ANA is the initial next best step for suspicion of DILE by hydralazine, it is important to consider the diagnosis without ANA positivity.

show abstract

“…Previous hydralazine PK studies reported nonlinearity with single doses higher than 100-150 mg. 9 Because both pharmacological activity and toxicity are attributed to parent drug exposure, caution is suggested with high-dose hydralazine during pregnancy. [54][55][56] Adverse effects and complications when parenteral hydralazine is needed during pregnancy include placental abruption, increased risk of surgical delivery, maternal oliguria, altered fetal heart rate, and low Apgar scores at 1 minute. 57 NAT2 slow acetylators, especially in female patients, have been found to have increased risk of developing severe adverse events (eg, systemic lupus erythematosus) with highdose hydralazine (>200 mg/day).…”

Section: Discussionmentioning

confidence: 99%

Effect of N‐Acetyltransferase 2 Genotype on the Pharmacokinetics of Hydralazine During Pregnancy

Han

Ryu

Cusumano

et al. 2019

The Journal of Clinical Pharma

View full text Add to dashboard Cite

Hydralazine, an antihypertensive agent used during pregnancy, undergoes N‐acetylation primarily via N‐acetyltransferase 2 (NAT2) to form 3‐methyl‐1,2,4‐triazolo[3,4‐a]phthalazine (MTP). To characterize the steady‐state pharmacokinetics (PK) of hydralazine during pregnancy and evaluate the effects of NAT2 genotype on hydralazine and MTP PK during pregnancy, 12 pregnant subjects received oral hydralazine (5‐25 mg every 6 hours) in mid‐ (n = 5) and/or late pregnancy (n = 8). Serial blood samples were collected over 1 dosing interval, and steady‐state noncompartmental PK parameters were estimated. Subjects were classified as either (rapid acetylators, n = 6) or slow acetylators (SAs, n = 6) based on NAT2 genotype. During pregnancy, when compared with the SA group, the RA group had faster weight‐adjusted hydralazine apparent oral clearance (70.0 ± 13.6 vs 20.1 ± 6.9 L/h, P < .05), lower dose‐normalized area under the concentration‐time curve (AUC; 1.5 ± 0.8 vs 5.9 ± 3.7 ng·h/mL, P < .05), lower dose‐normalized peak concentrations (0.77 ± 0.51 vs 4.04 ± 3.18 ng/mL, P < .05), and larger weight‐adjusted apparent oral volume of distribution (302 ± 112 vs 116 ± 45 L/kg, P < .05). Furthermore, the MTP/hydralazine AUC ratio was ∼10‐fold higher in the RA group (78 ± 30 vs 8 ± 3, P < .05) than in the SA group. No gestational age or dose‐dependent effects were observed, possibly because of the small sample size. This study describes for the first time, the PK of oral hydralazine and its metabolite, MTP, during pregnancy, and confirmed that the PK of oral hydralazine is NAT2 genotype dependent during pregnancy.

show abstract

Hydralazine Induced Lupus Syndrome Presenting with Recurrent Pericardial Effusion and a Negative Antinuclear Antibody

Cited by 13 publications

References 10 publications

Antinuclear antibody-negative lupus? An ominous presentation of hydralazine-induced lupus syndrome

Antinuclear antibody-negative lupus? An ominous presentation of hydralazine-induced lupus syndrome

ANA-Negative Hydralazine-Induced Pericardial Effusion

Effect of N‐Acetyltransferase 2 Genotype on the Pharmacokinetics of Hydralazine During Pregnancy

Contact Info

Product

Resources

About