SHM Converge Scientific Abstract ePoster Gallery-A Rare Case of Hydralazine-Induced Diffuse Alveolar Hemorrhage

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This case report describes a 74-year-old man who developed hydralazine-induced diffuse alveolar hemorrhage (DAH), a rare but potentially life-threatening complication. He presented with bloody cough, shortness of breath, night sweats, dark urine, anemia, hypoxia, and worsening kidney function after taking hydralazine 25 mg three times daily for about one year for hypertension.<br /><br />Initial evaluation raised concern for infection, vasculitis, or pulmonary-renal syndrome. Chest imaging showed worsening infiltrates and ground-glass opacities. Laboratory findings included hematuria and proteinuria, elevated creatinine, low hemoglobin, and positive dsDNA antibodies, though several autoimmune markers such as ANA, anti-GBM, MPO, PR3, and anti-histone antibodies were negative. Hydralazine was stopped on admission.<br /><br />Because of kidney injury and hematuria, a renal biopsy was performed and showed acute tubular necrosis without crescentic glomerulonephritis or fibrinoid necrosis. A bronchoalveolar lavage demonstrated progressively bloodier samples, confirming diffuse alveolar hemorrhage. The patient was treated with methylprednisolone, received blood transfusions, and improved clinically, with oxygen requirements resolving by hospital day 5.<br /><br />The authors emphasize that hydralazine can cause drug-induced lupus, vasculitis, glomerulonephritis, and pulmonary hemorrhage. Although this patient lacked some classic serologic findings, the clinical picture strongly supported hydralazine-induced ANCA vasculitis with DAH. They note that risk is higher with older age, female sex, recent hydralazine initiation, and higher doses, but serious toxicity can occur even at lower doses.<br /><br />The main takeaway is that unexplained pulmonary hemorrhage in a patient taking hydralazine should prompt immediate consideration of hydralazine-induced vasculitis, since early recognition and treatment with steroids or stronger immunosuppression in severe cases can be lifesaving.

Asset Subtitle

Daria Hoang

Meta Tag

Author List Daria Hoang, Farzana Hoque, Joshua S. Kim

Category Clinical Vignettes

Concept Hydralazine

Concept ANCA-Associated Vasculitis

Concept Diffuse Alveolar Hemorrhage

Concept Pulmonary-Renal Syndrome

Concept Corticosteroids

Distinguished Non-Finalist

Presenter Organization Saint Louis University School of Medicine

Presenting Author Daria Hoang

Track Adult

Keywords

hydralazine

diffuse alveolar hemorrhage

DAH

ANCA vasculitis

pulmonary-renal syndrome

drug-induced lupus

hematuria

proteinuria

renal biopsy

methylprednisolone

Hydralazine

ANCA-Associated Vasculitis

Diffuse Alveolar Hemorrhage

Pulmonary-Renal Syndrome

Corticosteroids