Overlapping Syndromes: Drug-Induced Vasculitis From Hydralazine With Positive Antinuclear Antibodies

Abstract

Hydralazine is an antihypertensive medication that has been associated with drug-associated autoimmune syndromes like interstitial lung disease, pauci-immune glomerulonephritis, and hypocomplementemia. Hydralazine-induced ANCA-associated vasculitis and hydralazine induced positive antinuclear antibodies are rare. Clinical manifestations range from arthralgia, petechiae, or rash to multiorgan involvement. When presented as pulmonary-renal syndrome, it can be rapidly progressive and fatal. Here, we describe a case of hydralazine-associated vasculitis with rapidly progressive glomerulonephritis and highlight the importance of early diagnosis and prompt treatment.

Keywords: ANCA vasculitis; Hydralazine; kidney injury; lupus.

Figure 1.

The kidney biopsy specimen contained 32 glomeruli, 2 of which were globally sclerosed and about 5% to 10% interstitial fibrosis.

Figure 2.

Cellular crescent identified.

Figure 3.

Electron microscopy showed moderated foot process effacement of podocytes with corrugation of glomerular basement membranes without significant subepithelial or subendothelial immune complex deposits.