Hydralazine-Induced Lupus Syndrome Manifesting as Large Pericardial Effusion

Abstract

Hydralazine-induced lupus syndrome (HILS) is a rare clinical entity with variable manifestations. Pericardial involvement is an uncommon but serious manifestation of the condition. In this report, we present a case of large symptomatic pericardial effusion secondary to HILS. We highlight the important considerations in the evaluation and management of this rare syndrome. HILS should be considered in the differential diagnosis for cardiac tamponade of otherwise unclear etiology in patients taking 100 mg daily or more of hydralazine for longer than three months. A temporal association between the offending drug and presenting symptoms, resolution of symptoms upon discontinuation, and a positive anti-histone antibody test can all support the diagnosis of this syndrome.

Keywords: drug-induced lupus (dil); hydralazine-induced lupus syndrome; pericardial effusion.

Figure 1. One-view upright anterior-posterior chest radiograph

The image shows cardiomegaly with large cardiac silhouette, and low lung volumes. Red arrows highlight enlarged right ventricle

Figure 2. Computed tomography image

The image demonstrates large pericardial effusion (yellow arrows denote outline of pericardial effusion surrounding cardiac silhouette)

Figure 3. 12-lead electrocardiogram

The image shows low voltage QRS complexes with sinus tachycardia and electrical alternans (blue arrows demonstrate subtle beat-to-beat variation in QRS voltage amplitude); no evidence of PR segment or ST segment abnormalities