SHM Converge Scientific Abstract ePoster Gallery-Over the Hils: A Unique Presentation of Hydralazine Induced Lupus

Pdf Summary

This case report describes hydralazine-induced lupus syndrome (HILS) in a 62-year-old man with ESRD on hemodialysis, CAD, and a recently closed atrial septal defect. He developed recurrent pericardial effusions soon after ASD closure, which were initially treated with colchicine and then a pericardial window. He later developed persistent left pleural effusions requiring multiple thoracenteses and eventual hospitalization.<br /><br />On admission, imaging showed a large left pleural effusion. Therapeutic thoracentesis removed 400 mL of transudative fluid and improved his symptoms. Because the effusions kept recurring, thoracic surgery was consulted for possible VATS decortication. During the workup, autoimmune testing showed a negative ANA, but anti-histone antibodies were strongly positive. Since he was taking hydralazine 100 mg twice daily, this medication was identified as the likely cause of drug-induced lupus. Hydralazine was stopped, after which the pleural effusions improved, though they did not fully resolve. He ultimately underwent VATS decortication and pleurodesis for more definitive control.<br /><br />The report highlights key features of HILS: it occurs in a notable minority of hydralazine users, is often dose-dependent, and may appear months or even years after starting therapy. Although ANA is usually positive, anti-histone antibodies can confirm the diagnosis even when ANA is negative. Pericardial involvement is uncommon but recognized. The main treatment is discontinuation of hydralazine, which may be sufficient for symptom resolution.

Asset Subtitle

Vivekanand Tatineni

Meta Tag

Author List Deepa Namburi, Kapil Mehta, Vivekanand Tatineni

Category Clinical Vignettes

Concept Minocycline-Induced Lupus

Concept Hydralazine

Concept Anti-Histone Antibody

Concept Drug Discontinuation

Concept Antinuclear Antibodies

Distinguished Finalist

Presenter Organization Ascension St. Vincent Hospital, Indianapolis

Presenting Author Vivekanand Tatineni

Track Adult

Keywords

hydralazine-induced lupus syndrome

HILS

anti-histone antibodies

pleural effusion

pericardial effusion

drug-induced lupus

hemodialysis

end-stage renal disease

VATS decortication

hydralazine discontinuation

Minocycline-Induced Lupus

Hydralazine

Anti-Histone Antibody

Drug Discontinuation

Antinuclear Antibodies