Page 28 - Delaware Medical Journal - March/April 2020

A Common Anti-Hypertensive Causing ANCA-Associated Pauci-Immune Vasculitis
Catherine Teskin, DO; Michael Goulet, DO; Ageetpal Hans, MD
Objective: The objective of this case is to report on a lesser-known potential adverse side-effect, antineutrophil cytoplasmic antibodies (ANCA)-associated pauci-immune vasculitis, of a common anti-hypertensive, hydralazine.
Methods: We present clinical context, laboratory findings, and treatment related to this case, as well as a review of relevant literature.
Results: 62-year-old male with chronic kidney disease stage 2, obstructive sleep apnea, hypertension, and heart failure with reduced ejection fraction was referred to nephrology for uncontrolled hypertension. His antihypertensive therapy included hydrochlorothiazide, irbesartan, furosemide, spironolactone, labetalol, and hydralazine. Patient reported a year of worsening fatigue. Patient later found to have markedly worsened renal function as well as significant proteinuria, concerning for hydralazine-induced vasculitis. Further work-up revealed elevated myeloperoxidase (MPO) antibody
in a P-ANCA pattern and renal biopsy with light microscopy revealed focal segmental necrotizing and crescentic glomerulonephritis. Immunofluorescence was negative for antigen antibody immune complexes. Hydralazine was discontinued and the patient was treated with glucocorticoids and Rituximab with improvement in renal functioning.
Conclusion: This case report demonstrates the importance of doing a thorough medication reconciliation with common culprit medications inducing vasculitis in mind when encountering patients with a rise in serum creatinine or urinalysis with significant blood or proteinuria.
Keywords: Hydralazine, vasculitis, MPO antibody
76 Del Med J | March/April 2020 | Vol. 92 | No. 2
Abstract