# Double Trouble: A Case Report of Hydralazine-Induced Vasculitis and Lupus

## TL;DR

A 77-year-old woman developed severe drug-induced lupus and vasculitis after taking hydralazine, affecting multiple organs and requiring urgent medical attention.

## Contribution

This case report highlights the rare but severe multi-organ complications of hydralazine-induced autoimmune syndrome.

## Key findings

- The patient experienced hypoxic respiratory failure due to diffuse alveolar hemorrhage.
- Acute kidney injury with crescentic glomerulonephritis and pancytopenia were observed.
- Serologic tests confirmed a drug-induced autoimmune syndrome with positive ANA, dsDNA, anti-histone, and P-ANCA.

## Abstract

We present a rare case of hydralazine-induced antineutrophil cytoplasmic antibody (ANCA) vasculitis and lupus, characterized by the simultaneous and severe involvement of multiple organ systems. Following outpatient hydralazine dose escalation, a 77-year-old woman developed hypoxic respiratory failure secondary to diffuse alveolar hemorrhage, acute kidney injury with crescentic glomerulonephritis, and pancytopenia. Serologic testing revealed positive antinuclear antibody (ANA), dsDNA, anti-histone antibody, and P-ANCA, supporting the diagnosis of drug-induced autoimmune syndrome. This case highlights the risk for severe multi-organ dysfunction in drug-induced lupus and vasculitis, emphasizing the need for vigilance in recognizing such complications.