Hydralazine-Induced Anti-neutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis

Abstract

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis comprises several conditions involving vascular destruction that extends into tissue necrosis. There are several autoimmune and environmental causes implicated in the disease progression; among these is drug-induced vasculitis caused by hydralazine use. Hydralazine-induced vasculitis is an uncommon potential complication of the medication and can progress to multisystem involvement and eventually advance to end-organ damage and renal failure. Our patient presented with symptoms of lower extremity edema, dyspnea, and a nonproductive cough eventually resulting in the identification of hydralazine-induced ANCA-associated vasculitis with hypocomplementemia and positive anti-histone antibody. Due to the prevalence of hydralazine as a cardiac drug, physicians managing patients on the medication should have a high index of suspicion of the potential for vasculitis in order to promote prompt diagnosis and treatment of the ANCA-vasculitis.

Keywords: anca associated vasculitis; anti-histone antibody; drug-induced vasculitis; hydralazine; hydralazine associated vasculitis.

Figure 1. Urinalysis with brightfield illumination revealing red blood cell casts with dysmorphic red blood cells indicating glomerulonephritic process.

Figure 2. Renal biopsies (A) with hematoxylin and eosin stain visualized under light microscopy showing inflammatory cells and fibrocellular deposition, and (B) with glomerular and capillary wall stain visualized under immunofluorescence microscopy showing immune complex deposition.