Hydralazine-induced ANCA vasculitis with pulmonary renal syndrome: a rare clinical presentation

Int Urol Nephrol. 2012 Dec;44(6):1907-9. doi: 10.1007/s11255-011-9989-7. Epub 2011 May 17.


Hydralazine is a commonly used drug for treatment of hypertension and is known to cause drug-induced lupus erythematosus. It has rarely been reported to cause anti neutrophil cytoplasmic antibody positive vasculitis, a life-threatening complication. Presentation could be extremely variable delaying diagnosis. Although drug-induced vasculitis has been infrequently associated with rapidly progressing glomerulonephritis, pulmonary involvement presenting as pulmonary renal syndrome is extremely rare. We report a case of hydralazine-induced vasculitis presenting as pulmonary renal syndrome with fatal outcome even after aggressive treatment. Numerous antibodies are associated with hydralazine including anti myeloperoxidase antibody, anti-nuclear antibody, anti-histone antibody, and anti-elastase antibody. Additionally, we also report the presence of anti-phospholipid antibodies specific to anti-cardiolipin, anti-beta2 glycoprotein, and anti-phosphatid that have not been previously reported. We conclude that early diagnosis and prompt discontinuation of the drug is necessary for the treatment of hydralazine-induced anti neutrophil cytoplasmic antibody vasculitis.

Publication types

  • Case Reports

MeSH terms

  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / chemically induced*
  • Antihypertensive Agents / adverse effects*
  • Glomerulonephritis / chemically induced*
  • Hemorrhage / chemically induced*
  • Humans
  • Hydralazine / adverse effects*
  • Lung Diseases / chemically induced*
  • Male
  • Middle Aged


  • Antihypertensive Agents
  • Hydralazine

Supplementary concepts

  • Rapidly progressive glomerulonephritis with pulmonary hemorrhage