Department of Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York City, NY, USA.
Department of Pathology and Laboratory Medicine, Icahn School of Medicine, The Mount Sinai Hospital, New York City, NY, USA.
Am J Case Rep. 2021 May 16;22:e931263. doi: 10.12659/AJCR.931263.
BACKGROUND Hydralazine, a potent vasodilator widely used to treat hypertension, has been implicated in an increasing number of cases of drug-induced autoimmune diseases in recent years. However, antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis secondary to hydralazine use has rarely been described and most reported cases involved multi-organ-related vasculitis, including skin and lung-kidney manifestations. ANCA-associated vasculitis is an immune-inflammatory condition characterized by necrotizing vasculitis with few or no immune deposits, predominantly affecting small vessels. The fact that the vasculitis is associated with hydralazine use and improves with discontinuation of hydralazine supports the diagnosis of hydralazine-induced disease. The case we report is a hydralazine-induced, ANCA-associated, pauci-immune crescentic glomerulonephritis with a presentation limited to the kidneys. CASE REPORT A 66-year-old woman was admitted to the hospital for worsening renal function over a month with no symptoms. Serology work-up was significantly positive for antinuclear, perinuclear ANCA, anti-histone, anti-double-stranded DNA, anti-cardiolipin, and anti-myeloperoxidase antibodies. The patient ultimately underwent a kidney biopsy, which revealed pauci-immune crescentic glomerulonephritis. Her kidney function improved with cessation of hydralazine as well as therapy with pulse steroids. CONCLUSIONS Hydralazine is commonly prescribed to treat hypertension. Healthcare providers should be aware of potentially severe hydralazine-induced ANCA-associated vasculitis, which can present with various clinical manifestations. Serologic studies have indicated that it has features that overlap with lupus. Biopsy is helpful for making a definitive diagnosis and developing individual treatment plans. Early diagnosis, cessation of the offending drug, and initiation of immunosuppressive therapy are key for favorable prognosis.
肼屈嗪是一种强效血管扩张剂，广泛用于治疗高血压，近年来越来越多的药物诱导自身免疫性疾病与肼屈嗪有关。然而，肼屈嗪引起的抗中性粒细胞胞质抗体（ANCA）相关性血管炎很少被描述，大多数报道的病例涉及多器官相关血管炎，包括皮肤和肺-肾表现。ANCA 相关性血管炎是一种免疫炎症性疾病，其特征为坏死性血管炎，很少或没有免疫沉积物，主要影响小血管。血管炎与肼屈嗪的使用有关，并且在停用肼屈嗪后改善，这支持肼屈嗪诱导疾病的诊断。我们报告的病例是肼屈嗪诱导的、ANCA 相关性、少免疫性新月体肾小球肾炎，表现仅限于肾脏。
一名 66 岁女性因肾功能恶化超过一个月而入院，无任何症状。血清学检查明显呈抗核、核周型 ANCA、抗组蛋白、抗双链 DNA、抗心磷脂和抗髓过氧化物酶抗体阳性。最终，该患者接受了肾脏活检，结果显示少免疫性新月体肾小球肾炎。停用肼屈嗪以及脉冲类固醇治疗后，患者的肾功能得到改善。
肼屈嗪常用于治疗高血压。医护人员应注意潜在的严重肼屈嗪诱导的 ANCA 相关性血管炎，其临床表现多样。血清学研究表明，它具有与狼疮重叠的特征。活检有助于明确诊断并制定个体化治疗方案。早期诊断、停用致病药物和启动免疫抑制治疗是良好预后的关键。
