A Challenging Twist in Pulmonary Renal Syndrome
Case. We report a rare case of hydralazine-induced anti-neutrophil cytoplasmic antibody-associated vasculitis. A 75-year-old African American woman with history of high blood pressure on hydralazine for 3 years presented with acute onset of shortness of breath and hemoptysis. Lab workup revealed a s...
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| Format: | Article |
| Language: | English |
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Wiley
2014-01-01
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| Series: | Case Reports in Rheumatology |
| Online Access: | http://dx.doi.org/10.1155/2014/516362 |
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| author | Rajaie Namas Bernard Rubin Wamidh Adwar Alireza Meysami |
| author_facet | Rajaie Namas Bernard Rubin Wamidh Adwar Alireza Meysami |
| author_sort | Rajaie Namas |
| collection | DOAJ |
| description | Case. We report a rare case of hydralazine-induced anti-neutrophil cytoplasmic antibody-associated vasculitis. A 75-year-old African American woman with history of high blood pressure on hydralazine for 3 years presented with acute onset of shortness of breath and hemoptysis. Lab workup revealed a severe normocytic anemia and a serum creatinine of 5.09 mg/dL (baseline 0.9). Bronchoscopy demonstrated active pulmonary hemorrhage. A urine sample revealed red cell casts and a renal biopsy demonstrated pauci-immune, focally necrotizing glomerulonephritis with small crescents consistent with possible anti-neutrophil cytoplasmic antibody-positive renal vasculitis. Serologies showed high-titer MPO-ANCA and high-titer anti-histone antibodies. She was treated with intravenous steroids and subsequently with immunosuppression after cessation of hydralazine. The patient was subsequently discharged from hospital after a rapid clinical improvement. Conclusion. Hydralazine-induced anti-neutrophil cytoplasmic antibody-positive renal vasculitis is a rare adverse effect and can present as a severe vasculitic syndrome with multiple organ involvement. Features of this association include the presence of high titer of anti-myeloperoxidase anti-neutrophil cytoplasmic antibody with multiantigenicity, positive anti-histone antibodies, and the lack of immunoglobulin and complement deposition. Prompt cessation of hydralazine may be sufficient to reverse disease activity but immunosuppression may be needed. |
| format | Article |
| id | doaj-art-208b16ac66124933a5f29ec6edf2c1bd |
| institution | Kabale University |
| issn | 2090-6889 2090-6897 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Rheumatology |
| spelling | doaj-art-208b16ac66124933a5f29ec6edf2c1bd2025-02-03T05:52:20ZengWileyCase Reports in Rheumatology2090-68892090-68972014-01-01201410.1155/2014/516362516362A Challenging Twist in Pulmonary Renal SyndromeRajaie Namas0Bernard Rubin1Wamidh Adwar2Alireza Meysami3Department of Internal Medicine, Division of Rheumatology, Henry Ford Hospital, Wayne State University, Detroit, MI 48202, USADepartment of Internal Medicine, Division of Rheumatology, Henry Ford Hospital, Wayne State University, Detroit, MI 48202, USADepartment of Pathology, Henry Ford Hospital, Wayne State University, Detroit, MI 48202, USADepartment of Internal Medicine, Division of Rheumatology, Henry Ford Hospital, Wayne State University, Detroit, MI 48202, USACase. We report a rare case of hydralazine-induced anti-neutrophil cytoplasmic antibody-associated vasculitis. A 75-year-old African American woman with history of high blood pressure on hydralazine for 3 years presented with acute onset of shortness of breath and hemoptysis. Lab workup revealed a severe normocytic anemia and a serum creatinine of 5.09 mg/dL (baseline 0.9). Bronchoscopy demonstrated active pulmonary hemorrhage. A urine sample revealed red cell casts and a renal biopsy demonstrated pauci-immune, focally necrotizing glomerulonephritis with small crescents consistent with possible anti-neutrophil cytoplasmic antibody-positive renal vasculitis. Serologies showed high-titer MPO-ANCA and high-titer anti-histone antibodies. She was treated with intravenous steroids and subsequently with immunosuppression after cessation of hydralazine. The patient was subsequently discharged from hospital after a rapid clinical improvement. Conclusion. Hydralazine-induced anti-neutrophil cytoplasmic antibody-positive renal vasculitis is a rare adverse effect and can present as a severe vasculitic syndrome with multiple organ involvement. Features of this association include the presence of high titer of anti-myeloperoxidase anti-neutrophil cytoplasmic antibody with multiantigenicity, positive anti-histone antibodies, and the lack of immunoglobulin and complement deposition. Prompt cessation of hydralazine may be sufficient to reverse disease activity but immunosuppression may be needed.http://dx.doi.org/10.1155/2014/516362 |
| spellingShingle | Rajaie Namas Bernard Rubin Wamidh Adwar Alireza Meysami A Challenging Twist in Pulmonary Renal Syndrome Case Reports in Rheumatology |
| title | A Challenging Twist in Pulmonary Renal Syndrome |
| title_full | A Challenging Twist in Pulmonary Renal Syndrome |
| title_fullStr | A Challenging Twist in Pulmonary Renal Syndrome |
| title_full_unstemmed | A Challenging Twist in Pulmonary Renal Syndrome |
| title_short | A Challenging Twist in Pulmonary Renal Syndrome |
| title_sort | challenging twist in pulmonary renal syndrome |
| url | http://dx.doi.org/10.1155/2014/516362 |
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