Hydralazine-Induced ANCA Associated Vasculitis (AAV) Presenting with Pulmonary-Renal Syndrome (PRS): A Case Report with Literature Review

Curr Cardiol Rev. 2021;17(2):182-187. doi: 10.2174/1573403X16666200518092814.

Abstract

Hydralazine, an arterial vasodilator, is a widely used medication for the management of hypertension and heart failure, especially for patients who cannot tolerate the use of ACEIs or ARBs. It is generally well-tolerated and has a safe profile in pregnancy. However, hydralazine can induce immune-mediated side effects, such as hydralazine-induced lupus and less commonly hydralazine- induced ANCA vasculitis. The latter most commonly affects the kidneys with or without other organ involvement. There are several cases reported in the literature of hydralazine-induced ANCA associated vasculitis (AAV) that have pulmonary manifestations, also known as hydralazine- induced pulmonary-renal syndrome (PRS), a condition with a high risk of mortality. We are reporting a case of Hydralazine-induced ANCA associated glomerulonephritis with severe diffuse alveolar hemorrhage (DAH). In addition, we will review the current literature and discuss the importance of prompt diagnosis and early management to decrease mortality and morbidity associated with this serious condition.

Keywords: Hydralazine; heart failure; hypertension; pulmonary hemorrhage; pulmonary-renal syndrome.; vasculitis.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Aged
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis* / chemically induced
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis* / diagnosis
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis* / pathology
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis* / therapy
  • Female
  • Glomerulonephritis* / chemically induced
  • Glomerulonephritis* / diagnosis
  • Glomerulonephritis* / pathology
  • Glomerulonephritis* / therapy
  • Heart Failure
  • Hemorrhage* / chemically induced
  • Hemorrhage* / diagnosis
  • Hemorrhage* / pathology
  • Hemorrhage* / therapy
  • Humans
  • Hydralazine / adverse effects*
  • Hydralazine / therapeutic use
  • Hypertension / drug therapy
  • Lung / diagnostic imaging
  • Lung / pathology
  • Lung Diseases* / chemically induced
  • Lung Diseases* / diagnosis
  • Lung Diseases* / pathology
  • Lung Diseases* / therapy
  • Vasodilator Agents / adverse effects*
  • Vasodilator Agents / therapeutic use

Substances

  • Vasodilator Agents
  • Hydralazine

Supplementary concepts

  • Rapidly progressive glomerulonephritis with pulmonary hemorrhage