Video: Every Case Tells a Story| Webinar: ACR/CHEST ILD Guidelines in Practice

An official publication of the ACR and the ARP serving rheumatologists and rheumatology professionals

  • Conditions
    • Axial Spondyloarthritis
    • Gout and Crystalline Arthritis
    • Myositis
    • Osteoarthritis and Bone Disorders
    • Pain Syndromes
    • Pediatric Conditions
    • Psoriatic Arthritis
    • Rheumatoid Arthritis
    • Sjögren’s Disease
    • Systemic Lupus Erythematosus
    • Systemic Sclerosis
    • Vasculitis
    • Other Rheumatic Conditions
  • FocusRheum
    • ANCA-Associated Vasculitis
    • Axial Spondyloarthritis
    • Gout
    • Psoriatic Arthritis
    • Rheumatoid Arthritis
    • Systemic Lupus Erythematosus
  • Guidance
    • Clinical Criteria/Guidelines
    • Ethics
    • Legal Updates
    • Legislation & Advocacy
    • Meeting Reports
      • ACR Convergence
      • Other ACR meetings
      • EULAR/Other
    • Research Rheum
  • Drug Updates
    • Analgesics
    • Biologics/DMARDs
  • Practice Support
    • Billing/Coding
    • EMRs
    • Facility
    • Insurance
    • QA/QI
    • Technology
    • Workforce
  • Opinion
    • Patient Perspective
    • Profiles
    • Rheuminations
      • Video
    • Speak Out Rheum
  • Career
    • ACR ExamRheum
    • Awards
    • Career Development
  • ACR
    • ACR Home
    • ACR Convergence
    • ACR Guidelines
    • Journals
      • ACR Open Rheumatology
      • Arthritis & Rheumatology
      • Arthritis Care & Research
    • From the College
    • Events/CME
    • President’s Perspective
  • Search

Case Report: Hydralazine-Induced ANCA-Associated Vasculitis

William J. Scheuing, MD, Nitasha Kumar, MD, William Davis, MD, & Robert Quinet, MD  |  Issue: February 2021  |  February 16, 2021


William J. Scheuing, MDWilliam J. Scheuing, MD, is an internal medicine resident at Virginia Tech Carilion School of Medicine, Roanoke.

Nitasha Kumar, MDNitasha Kumar, MD, is a rheumatologist with Arthritis & Rheumatism Associates, in the Washington, D.C., area. She completed her rheumatology fellowship at Ochsner Medical Center, New Orleans.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

William Davis, MDWilliam Davis, MD, is the rheumatology department head and vice chair of education in the Department of Internal Medicine at Ochsner Health, New Orleans. He is a Master of the American College of Physicians and an ACR Fellow. He is also an associate professor for the University of Queensland, Brisbane/Ochsner Clinical School.

Robert Quinet, MD, FACPRobert Quinet, MD, FACP, is the director of the Ochsner Rheumatology Fellowship Program, Ochsner Health, New Orleans, and holds a clinical professorship at Louisiana State University Health Sciences Center School of Medicine and a clinical assistant professorship at Tulane Medical Center, both in New Orleans. He is also an ACR Fellow.

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

References

  1. Khan MA. Effect of hydralazine in hypertension. Br Med J. 1953 Jan 3;1(4800):27–29.
  2. Finks SW, Finks AL, Self TH. Hydralazine‐induced lupus: Maintaining vigilance with increased use in patients with heart failure. South Med J. 2006 Jan;99(1):18–22.
  3. Xiao X, Chang C. Diagnosis and classification of drug-induced autoimmunity (DIA). J Autoimmun. 2014 Feb–Mar;48–49:66–72. 
  4. Handler J. Hydralazine-induced lupus erythematosus. J Clin Hypertens (Greenwich). 2012 Feb;14(2):133–136.
  5. Taborda L, Amaral B, Isenberg D, et al. Drug-induced vasculitis. Adverse Drug Reaction Bulletin. 2013 Apr;279(1):1075–1078. 
  6. Marina VP, Malhotra D, Kaw D. Hydralazine-induced ANCA vasculitis with pulmonary renal syndrome: A rare clinical presentation. Int Urol Nephrol. 2012 Dec;
    44(6):1907–1909.
  7. Namas R, Rubin B, Adwar W, et al. A challenging twist in pulmonary renal syndrome. Case Rep Rheumatol. 2014;2014:516362.
  8. Kumar B, Strouse J, Swee M, et al. Hydralazine-associated vasculitis: Overlapping features of drug-induced lupus and vasculitis. Semin Arthritis Rheum. 2018 Oct;48(2):283–287.
  9. Agarwal G, Sultan G, Werner S, et al. Hydralazine induces myeloperoxidase and proteinase 3 anti-neutrophil cytoplasmic antibody vasculitis and leads to pulmonary renal syndrome. Case Rep Nephrol. 2014;2014:868590.
  10. Zuckerman R, Patel M, Costanzo E, et al. Hydralazine-associated adverse events: A report of two cases of hydralazine-induced ANCA vasculitis. J Bras Nefrol. 2018 Apr–Jun;40(2):193–197.
  11. Babar F, Posner JN, Obah EA. Hydralazine-induced pauci-immune glomerulonephritis: Intriguing case series with misleading diagnoses. J Community Hosp Intern Med Perspect. 2016 Apr 25;6(2):30632. 
  12. Dobre M, Wish J, Negrea L. Hydralazine-induced ANCA-positive pauci-immune glomerulonephritis: A case report and literature review. Ren Fail. 2009;31:745–748.
  13. Lionaki S, Hogan SL, Falk RJ, et al. Association between thyroid disease and its treatment with ANCA small-vessel vasculitis: A case–control study. Nephrol Dial Transplant. 2007 Dec;22(12):3508–3515.
  14. McKinnon RA, Nebert DW. Possible role of cytochromes P450 in lupus erythematosus and related disorders. Lupus. 1994 Dec;
    3(6):473–478.
  15. Hogan JJ, Markowitz GS, Radhakrishnan J. Drug-induced glomerular disease: Immune-mediated injury. Clin J Am Soc Nephrol. 2015 Jul 7;10(7):1300–1310.
  16. Magro CM, Momtahen S, Harp J. The distinctive histopathology of hydralazine- associated ANCA positive vasculitis: In vivo demonstration of NETosis. Eur J Dermatol. 2017 Feb 1;27(1):91–92.
  17. Somers EC, Richardson BC. Environmental exposures, epigenetic changes and the risk of lupus. Lupus. 2014 May;23(6):568–576.
  18. Chang C, Gershwin ME. Drugs and autoimmunity—a contemporary review and mechanistic approach. J Autoimmun. 2010 May;34(3):J266–J275.
  19. Nassberger L. The antihypertensive compounds hydralazine, dihydralazine and cadralazine and their metabolites inhibit myeloperoxidase activity as measured by chemiluminescence. Biochem Pharmacol. 1991 Oct 9;42(9):1844–1847.
  20. Timlin H, Liebowitz JE, Jaggi K, et al. Outcomes of hydralazine induced renal vasculitis. Eur J Rheumatol. 2018 Mar;5(1):5–8.
  21. Keasberry J, Frazier J, Isbel NM, et al. Hydralazine-induced anti-neutrophil cytoplasmic antibody-positive renal vasculitis presenting with a vasculitic syndrome, acute nephritis and a puzzling skin rash: A case report. J Med Case Rep. 2013 Jan 14;7:20.

Page: 1 2 3 4 | Single Page
Share: 

Filed under:ConditionsVasculitis Tagged with:ANCA-Associated Vasculitiscase reporthydralazinepulmonary-renal syndrome

Related Articles

    ACR Winter Rheumatology Symposium: Tips for ANCA Testing

    May 1, 2013

    How to select the correct testing method and interpret conflicting results from antineutrophil cytoplasmic antibody tests

    Case Report: Interstitial Lung Disease with Positive ANCA Test

    October 13, 2015

    “Worst of all is the pain in my calves,” she said. “It feels like burning deep inside.” So began my first encounter with a 69-year-old woman who was referred to rheumatology clinic for evaluation of two months of constitutional symptoms and a positive ANCA test, which had been ordered by her primary care doctor. Her…

    Case Report: Drug-Induced Lupus & ANCA-Associated Vasculitis Overlap

    February 16, 2021

    Drug-induced lupus erythe­matosus and ANCA-associated vasculitis (AAV) are both autoimmune conditions associated with the use of hydralazine, a commonly prescribed drug for hypertension and congestive heart failure. Although the pathogenesis is unknown, it is believed that hydralazine alters neutrophil and lymphocyte function and promotes exposure of antigens, leading to the development of anti-neutrophil antibodies (ANCA)…

    Fellow’s Forum Case Report: True Vasculitis or Vasculitis Mimic?

    October 1, 2012

    Rheumatologists face the emerging picture of cocaine and levamisole-associated vasculopathy in clinical practice

  • About Us
  • Meet the Editors
  • Issue Archives
  • Contribute
  • Advertise
  • Contact Us
  • Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies. ISSN 1931-3268 (print). ISSN 1931-3209 (online).
  • DEI Statement
  • Privacy Policy
  • Terms of Use
  • Cookie Preferences