Overlapping drug-induced vasculitis, ANCA-associated vasculitis, and lupus nephritis caused by low-dose hydralazine.
Female
Humans
Middle Aged
Lupus Nephritis
/ chemically induced
Hydralazine
/ adverse effects
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis
/ chemically induced
Antibodies, Antineutrophil Cytoplasmic
Hypertension
Lupus Erythematosus, Systemic
/ chemically induced
Renal Insufficiency
/ chemically induced
antineutrophil cytoplasmic antibody-associated vasculitis
drug-induced vasculitis
hydralazine
lupus nephritis
vasculitis
Journal
International journal of rheumatic diseases
ISSN: 1756-185X
Titre abrégé: Int J Rheum Dis
Pays: England
ID NLM: 101474930
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
received:
21
04
2023
accepted:
16
06
2023
medline:
2
11
2023
pubmed:
15
7
2023
entrez:
15
7
2023
Statut:
ppublish
Résumé
We present a case of drug-induced vasculitis secondary to low-dose hydralazine with overlapping features of antineutrophil cytoplasmic antibody-associated vasculitis and drug-induced lupus nephritis. A 52-year-old Hispanic woman with a medical history of resistant hypertension treated with hydralazine 10 mg twice daily for 1 year presented with generalized weakness, dizziness, nausea, vomiting, and gross hematuria. There was fever, tachycardia, leukocytosis, lactic acidosis, hyperkalemia, renal failure, and anemia. Chest computed tomography and bronchoscopy revealed a left lower lobe infiltrate and diffuse alveolar hemorrhage. Serologic testing was positive for anti-double-stranded DNA, anti-Smith, lupus anticoagulant, anti-histone, anti-cardiolipin IgM antibodies, and antineutrophil cytoplasmic antibodies (myeloperoxidase and proteinase 3). A kidney biopsy revealed crescentic glomerulonephritis with an overlapping finding of membranous nephropathy. Broad-spectrum antibiotics, immunosuppressants, corticosteroids, and plasmapheresis were initiated. The patient survived but required continuous hemodialysis. Although a few cases of simultaneous antibody-associated vasculitis and drug-induced lupus nephritis secondary to hydralazine use have been reported, this case is singular. Similar findings were previously reported with doses of 50-100 mg two to three times daily over 1-5 years. In our patient, a dose of only 10 mg twice daily for a year caused a severe disease presentation. This brings to light the combination of different vasculitides that can coexist and the potentially life-threatening adverse effects of low-dose hydralazine that should be kept in mind.
Identifiants
pubmed: 37452463
doi: 10.1111/1756-185X.14809
doi:
Substances chimiques
Hydralazine
26NAK24LS8
Antibodies, Antineutrophil Cytoplasmic
0
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
2272-2277Informations de copyright
© 2023 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.
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