Hydralazine-induced ANCA vasculitis with pulmonary renal syndrome: a rare clinical presentation

Marina, Vamsee Priya; Malhotra, Deepak; Kaw, Dinkar

doi:10.1007/s11255-011-9989-7

Cited by 17 publications

(11 citation statements)

References 8 publications

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“…Similar to the findings by Choi et al (5), kidney disease was common on presentation (81%), and patients had additional serologic evidence of an autoimmune process (96% ANA positive, 26% anti-dsDNA antibody positive, and 44% hypocomplementemia). Combined pulmonary-renal syndrome with hydralazine-associated AAV is rare, with only 15 suspected cases in the literature (39)(40)(41)(42). Given the overlap in the clinical presentation of hydralazine-associated SLE and AAV, both diagnoses should be considered.…”

Section: Drugs Associated With Aavmentioning

confidence: 99%

Drug-Induced Glomerular Disease

Hogan

Markowitz²,

Radhakrishnan

2015

Clinical Journal of the American Society of Nephrology

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Drug-induced autoimmune disease was initially described decades ago, with reports of vasculitis and a lupus-like syndrome in patients taking hydralazine, procainamide, and sulfadiazine. Over the years, multiple other agents have been linked to immune-mediated glomerular disease, often with associated autoantibody formation. Certain clinical and laboratory features may distinguish these entities from their idiopathic counterparts, and making this distinction is important in the diagnosis and management of these patients. Here, drug-induced, ANCA-associated vasculitis, drug-induced lupus, and drug-associated membranous nephropathy are reviewed.

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Section: Drugs Associated With Aavmentioning

confidence: 99%

Drug-Induced Glomerular Disease

Hogan

Markowitz²,

Radhakrishnan

2015

Clinical Journal of the American Society of Nephrology

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“…These antibodies either alone or by complex interaction with infection agents or genetic factors may contribute to the disease. Antibodies associated with hydralazine-induced vasculitis include MPO ANCA, ANA, anti-histone antibody, anti-elastase antibody, and anti-phospholipid antibody [10, 11]. Surprisingly, our patient was positive for PR3 ANCA in addition to MPO ANCA, ANA, and anti-histone antibody.…”

Section: Discussionmentioning

confidence: 79%

Hydralazine Induces Myeloperoxidase and Proteinase 3 Anti-Neutrophil Cytoplasmic Antibody Vasculitis and Leads to Pulmonary Renal Syndrome

Agarwal

Sultan

Werner

et al. 2014

Case Reports in Nephrology

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We report a case of hydralazine-induced ANCA-associated glomerulonephritis with pulmonary hemorrhage. A 62-year-old Hispanic man with hypertension, who was being treated with hydralazine 100 mg three times a day for four and half years, presented to the hospital with severe anemia. He had acute kidney injury and urinalysis showed proteinuria, dysmorphic RBCs, and rare RBC cast. CT scan of the chest revealed bilateral pulmonary ground-glass infiltrates. Transbronchial biopsy was consistent with pulmonary hemorrhage. Serologic tests showed high titer PR3 ANCA and, to a lesser extent, MPO ANCA. Kidney biopsy revealed focal segmental necrotizing glomerulonephritis with crescents, without evidence of immune complex deposits. Hydralazine was discontinued and the patient was treated with corticosteroids and intravenous cyclophosphamide. At one-year follow-up, he had no symptoms and anemia had resolved. Kidney function improved dramatically. Serology showed undetectable PR3 ANCA and minimally elevated MPO ANCA. To our knowledge, hydralazine-associated PR3 ANCA has not been previously reported. The possibility of ANCA systemic vasculitis should be included in the differential diagnosis of any patient with hydralazine use and pulmonary renal syndrome. This is a potentially life threatening condition requiring prompt cessation of the drug and treatment with glucocorticoids and immunosuppression.

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“…However, antibodies to ANA and antihistone, in the context of positive ANCA, are pathognomonic in drug-induced vasculitis. 4 Antihistone antibody positivity is not necessarily required for diagnosis; notably, published case reports have had a negative antihistone antibody, with positive ANCA. 5 The sensitivity of a positive screening test for antihistone antibodies for drug-induced lupus is 67% and the specificity is 95%.…”

Section: Discussionmentioning

confidence: 99%

Hereditary afibrinogenemia and pulmonary-renal hydralazine-induced vasculitis

Tsai-Nguyen

Modrykamien

Bredeweg

2019

Baylor University Medical Center Proceedings

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Combined pulmonary-renal hydralazine-induced vasculitis is rare, and hereditary afibrinogenemia is also rare. We present a case of a 62-year-old man with a history of hereditary afibrinogenemia who presented with hemoptysis and hematuria. Although he had prior episodes of hemoptysis that resolved with repletion of fibrinogen levels, a hydralazine-induced vasculitis was the ultimate cause of his recurrent hemoptysis and hematuria. Hydralazine was held and after transfusion with cryoprecipitate, he was treated with prednisone and rituximab.

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Hydralazine-induced ANCA vasculitis with pulmonary renal syndrome: a rare clinical presentation

Cited by 17 publications

References 8 publications

Drug-Induced Glomerular Disease

Drug-Induced Glomerular Disease

Hydralazine Induces Myeloperoxidase and Proteinase 3 Anti-Neutrophil Cytoplasmic Antibody Vasculitis and Leads to Pulmonary Renal Syndrome

Hereditary afibrinogenemia and pulmonary-renal hydralazine-induced vasculitis

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