Diagnostic dilemma: drug-induced vasculitis versus systemic vasculitis

BMJ Case Rep. 2023 Jul 10;16(7):e254736. doi: 10.1136/bcr-2023-254736.

Abstract

Drug-induced vasculitis can rarely cause inflammation and necrosis of blood vessel walls of both kidney and lung tissue. Diagnosis is challenging because of the lack of difference between systemic and drug-induced vasculitis in clinical presentation, immunological workup and pathological findings. Tissue biopsy guides diagnosis and treatment. Pathological findings must be correlated with clinical information to arrive at a presumed diagnosis of drug-induced vasculitis. We present a patient with hydralazine-induced antineutrophil cytoplasmic antibodies-positive vasculitis with a pulmonary-renal syndrome manifesting as pauci-immune glomerulonephritis and alveolar haemorrhage.

Keywords: drugs and medicines; renal system.

Publication types

  • Case Reports

MeSH terms

  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis* / chemically induced
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis* / complications
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis* / diagnosis
  • Antibodies, Antineutrophil Cytoplasmic
  • Glomerulonephritis* / chemically induced
  • Glomerulonephritis* / diagnosis
  • Humans
  • Hydralazine / adverse effects
  • Kidney / pathology
  • Lung Diseases* / etiology

Substances

  • Hydralazine
  • Antibodies, Antineutrophil Cytoplasmic