Hydralazine-Induced Vasculitis

Hydralazine is a commonly prescribed medication which is used in the treatment of hypertension. While it is generally considered to be a safe and effective treatment, in rare cases it can cause a serious side effect known as hydralazine-induced vasculitis. Here we discuss this rare presentation in the form of a case report in a 67-year-old female with a past medical history of chronic obstructive pulmonary disease (COPD), congestive heart failure, hypertension, hyperlipidemia, left renal artery stenosis status post stenting who presented in the nephrology office for evaluation of recent worsening kidney function, and on further evaluation was found to have hematuria and proteinuria in the urine analysis. On further workup, she was noted to have severely elevated myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) titers with renal biopsy revealed very focal crescentic glomerulonephritis, an increased number of occlusive red blood cell cast with acute tubular necrosis. Mild interstitial fibrosis of <20% was seen and a diagnosis of drug-induced vasculitis from hydralazine was made.