Acute Low-Dose Hydralazine-Induced Lupus Pneumonitis
A 35-year-old female was started on hydralazine 10 mg orally three times a day for treatment of postpartum hypertension. Three months later, after multiple unsuccessful courses of prednisone and antibiotics for presumed pneumonia and asthma exacerbations, her respiratory symptoms progressed in sever...
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| Format: | Article |
| Language: | English |
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Wiley
2017-01-01
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| Series: | Case Reports in Pulmonology |
| Online Access: | http://dx.doi.org/10.1155/2017/2650142 |
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| _version_ | 1832563812852563968 |
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| author | Sarah K. Holman Donique Parris Sarah Meyers Jason Ramirez |
| author_facet | Sarah K. Holman Donique Parris Sarah Meyers Jason Ramirez |
| author_sort | Sarah K. Holman |
| collection | DOAJ |
| description | A 35-year-old female was started on hydralazine 10 mg orally three times a day for treatment of postpartum hypertension. Three months later, after multiple unsuccessful courses of prednisone and antibiotics for presumed pneumonia and asthma exacerbations, her respiratory symptoms progressed in severity and she developed resting hypoxia. Previous diagnostic work-up included spirometry with a restrictive pattern, chest CT showing bilateral basilar consolidation, negative BAL, and nonspecific findings on lung biopsy of mild inflammatory cells. Review of systems was positive for arthralgia, lymphadenopathy, paresthesia, and fatigue that began four weeks after starting hydralazine. A clinical diagnosis of hydralazine-induced lupus (HIL) with pneumonitis was made. Antihistone antibodies were positive supporting a diagnosis of HIL. Management included cessation of hydralazine and a prolonged steroid taper. Within days, patient began improving symptomatically. Six weeks later, CT chest showed complete resolution of infiltrates. Genetic testing revealed she was heterozygous for N-acetyltransferase 2 (intermediate acetylator). Drug-induced lupus should be considered in patients with lupus-like symptoms taking medications with a known association. While the majority of HIL cases occur with high doses and prolonged treatment, cases of low-dose HIL have been reported in patients who are slow acetylators. |
| format | Article |
| id | doaj-art-e9cffdac23774cbb928caace38017afd |
| institution | Kabale University |
| issn | 2090-6846 2090-6854 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Pulmonology |
| spelling | doaj-art-e9cffdac23774cbb928caace38017afd2025-02-03T01:12:30ZengWileyCase Reports in Pulmonology2090-68462090-68542017-01-01201710.1155/2017/26501422650142Acute Low-Dose Hydralazine-Induced Lupus PneumonitisSarah K. Holman0Donique Parris1Sarah Meyers2Jason Ramirez3Notre Dame of Maryland University School of Pharmacy, 4701 North Charles St, Bunting 103, Baltimore, MD 21210, USAUniversity of Maryland School of Medicine, Baltimore, MD 21201, USADepartment of Family and Community Medicine, University of Maryland Medical Center, Baltimore, MD 21201, USADepartment of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USAA 35-year-old female was started on hydralazine 10 mg orally three times a day for treatment of postpartum hypertension. Three months later, after multiple unsuccessful courses of prednisone and antibiotics for presumed pneumonia and asthma exacerbations, her respiratory symptoms progressed in severity and she developed resting hypoxia. Previous diagnostic work-up included spirometry with a restrictive pattern, chest CT showing bilateral basilar consolidation, negative BAL, and nonspecific findings on lung biopsy of mild inflammatory cells. Review of systems was positive for arthralgia, lymphadenopathy, paresthesia, and fatigue that began four weeks after starting hydralazine. A clinical diagnosis of hydralazine-induced lupus (HIL) with pneumonitis was made. Antihistone antibodies were positive supporting a diagnosis of HIL. Management included cessation of hydralazine and a prolonged steroid taper. Within days, patient began improving symptomatically. Six weeks later, CT chest showed complete resolution of infiltrates. Genetic testing revealed she was heterozygous for N-acetyltransferase 2 (intermediate acetylator). Drug-induced lupus should be considered in patients with lupus-like symptoms taking medications with a known association. While the majority of HIL cases occur with high doses and prolonged treatment, cases of low-dose HIL have been reported in patients who are slow acetylators.http://dx.doi.org/10.1155/2017/2650142 |
| spellingShingle | Sarah K. Holman Donique Parris Sarah Meyers Jason Ramirez Acute Low-Dose Hydralazine-Induced Lupus Pneumonitis Case Reports in Pulmonology |
| title | Acute Low-Dose Hydralazine-Induced Lupus Pneumonitis |
| title_full | Acute Low-Dose Hydralazine-Induced Lupus Pneumonitis |
| title_fullStr | Acute Low-Dose Hydralazine-Induced Lupus Pneumonitis |
| title_full_unstemmed | Acute Low-Dose Hydralazine-Induced Lupus Pneumonitis |
| title_short | Acute Low-Dose Hydralazine-Induced Lupus Pneumonitis |
| title_sort | acute low dose hydralazine induced lupus pneumonitis |
| url | http://dx.doi.org/10.1155/2017/2650142 |
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