Hydralazine induced vasculitis with pulmonary-renal syndrome-A case report

• Published in: SN comprehensive clinical medicine 2023-01, Vol.5 (1), Article 70
• Main Authors: Jeyaruban, Andrew, Downie, Elizabeth, Ismail, Kasim A., Nandakoban, Hari
• Format: Article
• Language: English
• Subjects: Case Report; Medicine; Medicine & Public Health; Topical Collection on Medicine
• ISSN: 2523-8973; 2523-8973
• DOI: 10.1007/s42399-023-01404-4

Hydralazine is a medication commonly used for the management of hypertension. Its use is associated with autoimmune diseases including vasculitis. Pulmonary-renal syndrome is a less common presentation of hydralazine-induced vasculitis. This is the case of a female who presented with dyspnoea, purpuric rash, macroscopic haematuria and acute kidney injury. She had a history of hypertension, which was treated with hydralazine 100 mg twice daily. Urine microscopy revealed significant haematuria and proteinuria. CT chest showed bilateral ground glass opacities. Immunological testing revealed a positive perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA), double-stranded DNA (dsDNA) and anti-histone antibody. Renal biopsy showed focal and segmental proliferative glomerulonephritis with active cellular crescents. Hydralazine was ceased and she was commenced on induction treatment for ANCA vasculitis with methylprednisolone and cyclophosphamide. She entered remission but within six weeks represented with multiple severe infections. In this setting, her immunosuppression was changed to intravenous immunoglobulin. The patient remains in clinical remission. This is a case of a hydralazine-induced vasculitis presenting with pulmonary renal syndrome. This case demonstrates that there is a variable relationship between hydralazine use and the onset of vasculitis.