A simultaneous presentation of drug-induced lupus with drug-induced ANCA vasculitis secondary to hydralazine use in a patient with sarcoidosis

Diffuse Alveolar Hemorrhage Linked to Hydralazine

Hydralazine, a commonly prescribed vasodilator for hypertension, is associated with adverse effects such as vasculitis, glomerulonephritis, and drug-induced lupus. We present a rare case of hydralazine-induced diffuse alveolar hemorrhage (DAH) in a 74-year-old male with a history of hypertension. The patient was admitted with symptoms including hemoptysis, dyspnea, and dark urine. Initial findings included a biopsy-confirmed leukocytoclastic vasculitis, elevated MPO antibodies, and evidence of DAH on bronchoscopy. Despite the absence of glomerulonephritis, the patient exhibited signs of pulmonary-renal syndrome, including worsening renal function and anemia. The patient's condition improved significantly after cessation of hydralazine and initiation of intravenous methylprednisolone. This case underscores the importance of considering hydralazine-induced ANCA vasculitis in patients presenting with unexplained pulmonary hemorrhage, particularly when other common causes are ruled out. Early recognition and management are crucial to prevent potentially life-threatening complications associated with this rare condition.

Hydralazine-Induced Dual Antineutrophil Cytoplasmic Antibody Positive Vasculitis and Nephritis

Drug-induced autoimmunity occurs when exposure to a causative agent leads to serologic or clinical autoimmune responses. Syndromes that may be associated with drug-induced autoimmunity include antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) and drug-induced lupus (DIL). When drug-induced autoimmunity involves the kidney, histological patterns of injury include pauci-immune glomerulonephritis (GN), which occurs with AAV, and immune complex-mediated GN, which is associated with DIL. We present a case of hydralazine-induced dual ANCA-positive vasculitis and nephritis.