SHM Converge Scientific Abstract ePoster Gallery-It Was the Hydralazine, Dah!

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An 82-year-old woman with HFpEF, COPD, and hypertension presented with one month of worsening dyspnea, a week of scant hemoptysis, fatigue, new anemia, acute kidney injury, proteinuria, and hematuria. She was taking hydralazine for hypertension. Chest CT showed bilateral ground-glass opacities consistent with pulmonary hemorrhage. Workup revealed positive ANCA, ANA, and anti-myeloperoxidase antibodies, with negative anti-GBM and other autoimmune markers, and normal complements. Renal biopsy demonstrated pauci-immune necrotizing crescentic glomerulonephritis, supporting hydralazine-induced ANCA-associated vasculitis with pulmonary-renal syndrome and diffuse alveolar hemorrhage (DAH).<br /><br />The case highlights that hydralazine can trigger autoimmune vasculitis even after long-term use. Most cases involve anti-MPO (p-ANCA) and commonly affect the kidneys, but severe presentations may include DAH, which carries high mortality. Clinicians should suspect this diagnosis when a patient on hydralazine develops hypoxemia, hemoptysis, anemia, and renal abnormalities. CT findings of hemorrhage should prompt further evaluation, and bronchoscopy with bronchoalveolar lavage can confirm DAH.<br /><br />Treatment requires immediate discontinuation of hydralazine, immunosuppression with corticosteroids and cyclophosphamide, and often plasma exchange. In this case, hydralazine was stopped and the patient received steroids, plasma exchange, and cyclophosphamide, but her condition deteriorated and she ultimately died on comfort care. The report emphasizes the importance of early recognition and rapid treatment to improve outcomes in hydralazine-induced ANCA vasculitis with DAH.

Asset Subtitle

Lindsey Phillips

Meta Tag

Author List Adele Bernard, Angela Xue, Evan Raff, Lindsey Phillips

Category Clinical Vignettes

Concept Hydralazine-Induced ANCA-Associated Vasculitis

Concept Diffuse Alveolar Hemorrhage

Concept Pulmonary-Renal Syndrome

Concept Antineutrophil cytoplasmic antibody

Concept MPO-ANCA

Distinguished Non-Finalist

Presenter Organization University of North Carolina School of Medicine

Presenting Author Lindsey Phillips

Track Adult

Keywords

hydralazine

ANCA-associated vasculitis

anti-MPO

diffuse alveolar hemorrhage

pulmonary-renal syndrome

pauci-immune crescentic glomerulonephritis

hemoptysis

acute kidney injury

corticosteroids

plasma exchange

Hydralazine-Induced ANCA-Associated Vasculitis

Diffuse Alveolar Hemorrhage

Pulmonary-Renal Syndrome

Antineutrophil cytoplasmic antibody

MPO-ANCA