SHM Converge Scientific Abstract ePoster Gallery-Hydralazine Induced Vasculitis Masquerading as Hypertensive Crisis: A Deadly Complication of a Common Drug

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Northwell Health is New York State’s largest health care provider and private employer, committed to delivering high-quality care, educating health professionals, advancing biomedical research, promoting health education, and serving all community members regardless of ability to pay.  <br /><br />The document then presents a clinical case highlighting an uncommon but dangerous complication of a common medication: hydralazine-induced vasculitis. An 86-year-old woman with hypertension and heart failure was admitted with chest pain, dyspnea, severe hypertension, and signs that initially suggested hypertensive crisis and acute diastolic heart failure. She was treated with diuretics and her home hydralazine was restarted. Her condition then worsened: she developed hypotension, fever, acute kidney injury requiring hemodialysis, and progressive respiratory failure.  <br /><br />Imaging showed diffuse infiltrates and ground-glass opacities, and bedside ultrasound suggested pulmonary edema. During intubation, she produced copious red, frothy sputum that persisted even after dialysis. Bronchoscopy revealed diffuse alveolar hemorrhage, raising concern for vasculitis rather than heart failure alone. A renal biopsy confirmed drug-induced vasculitis.  <br /><br />Laboratory testing supported an autoimmune process, including low complement levels, very elevated inflammatory markers, anemia, renal dysfunction, positive p-ANCA and myeloperoxidase antibodies, high ANA, elevated histone antibody, and positive double-stranded DNA antibody. Cultures and infectious workup were negative.  <br /><br />The key teaching point is that hydralazine can rarely cause ANCA-associated vasculitis, which may mimic hypertensive emergency, pulmonary edema, or other rheumatologic disease. Because its presentation can be misleading and potentially fatal, clinicians should carefully review home medications and consider drug-induced syndromes early in patients with unexplained multisystem deterioration.

Asset Subtitle

Matthew Capustin

Meta Tag

Author List Matthew Capustin, Spencer F. Weintraub, Zubair Hasan

Category Clinical Vignettes

Concept Hydralazine

Concept ANCA-Associated Vasculitis

Concept Drug-Induced Vasculitis

Concept Medication Review

Concept Diffuse Alveolar Hemorrhage

Distinguished Non-Finalist

Presenter Organization Northwell Health

Presenting Author Matthew Capustin

Track Adult

Keywords

Northwell Health

hydralazine

vasculitis

ANCA-associated vasculitis

diffuse alveolar hemorrhage

acute kidney injury

pulmonary edema

hypertensive crisis

myeloperoxidase antibodies

drug-induced vasculitis

Hydralazine

ANCA-Associated Vasculitis

Drug-Induced Vasculitis

Medication Review

Diffuse Alveolar Hemorrhage