SHM Converge Scientific Abstract ePoster Gallery-The Dark Side of Hydralazine - A Case of Drug Induced Lupus and Anca Vasculitis

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This case describes an 87-year-old woman with stage 4 chronic kidney disease, hypertension, and heart failure who presented with fatigue, lightheadedness, cough, and worsening dyspnea, along with acute kidney injury and hyperkalemia. Her home medications included hydralazine and phenytoin. Evaluation showed elevated inflammatory markers, hematuria, proteinuria, pulmonary infiltrates on chest imaging, and ground-glass opacities on CT. Autoimmune testing revealed positive ANA, anti-dsDNA, MPO, and PR3 antibodies with an indeterminate ANCA. Kidney biopsy demonstrated necrotizing crescentic glomerulonephritis consistent with ANCA vasculitis, with electron microscopy showing features of both lupus and pauci-immune glomerulonephritis.<br /><br />Hydralazine and phenytoin were discontinued, and treatment with high-dose glucocorticoids and rituximab was started after biopsy confirmation. Her course was complicated by hemorrhagic shock from a perinephric hematoma, requiring dialysis. After a prolonged hospitalization, multiple readmissions, and eventual transition to hospice, she died five months after admission.<br /><br />The report highlights that hydralazine can cause drug-induced lupus and the rarer hydralazine-associated ANCA vasculitis, which may overlap and present with nonspecific symptoms such as fatigue, weakness, respiratory complaints, and acute kidney injury. Because onset can occur even after years of therapy, clinicians should maintain a high index of suspicion in patients taking hydralazine. Early recognition and prompt discontinuation of the drug are critical to prevent irreversible renal damage and death.

Asset Subtitle

Jenny Y. Shen

Meta Tag

Author List Jenny Y. Shen, John M. Bennett, Karyssa Harris

Category Clinical Vignettes

Concept Hydralazine

Concept Minocycline-Induced Lupus

Concept ANCA-Associated Vasculitis

Concept Acute Kidney Injury

Concept Pauci-Immune Glomerulonephritis

Distinguished Non-Finalist

Presenter Organization UR Medicine - Strong Memorial Hospital

Presenting Author Jenny Y. Shen

Track Adult

Keywords

hydralazine-associated ANCA vasculitis

drug-induced lupus

necrotizing crescentic glomerulonephritis

acute kidney injury

hyperkalemia

pulmonary infiltrates

anti-dsDNA antibodies

MPO and PR3 antibodies

rituximab treatment

chronic kidney disease

Hydralazine

Minocycline-Induced Lupus

ANCA-Associated Vasculitis

Acute Kidney Injury

Pauci-Immune Glomerulonephritis