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Acute Low-Dose Hydralazine-Induced Lupus Pneumonitis
Sarah K Holman1, Donique Parris2, Sarah Meyers3
1Notre Dame of Maryland University School of Pharmacy, 4701 North Charles St, Bunting 103, Baltimore, MD 21210, USA.
Case Reports in Pulmonology
|September 22, 2017
Summary
Hydralazine can cause drug-induced lupus (DIL) with pneumonitis, even at low doses, particularly in slow acetylator individuals. Prompt cessation of hydralazine and steroid treatment led to rapid symptom resolution and complete lung recovery.
Area of Science:
- Rheumatology
- Pulmonology
- Clinical Pharmacology
Background:
- Postpartum hypertension treatment with hydralazine can unmask or induce autoimmune conditions.
- Drug-induced lupus (DIL) is a recognized adverse effect of certain medications, including hydralazine.
- Pneumonitis is a rare but serious manifestation of DIL.
Observation:
- A 35-year-old female developed progressive respiratory symptoms, hypoxia, and systemic lupus erythematosus-like symptoms after initiating low-dose hydralazine.
- Diagnostic work-up revealed restrictive spirometry, bilateral lung consolidation, and positive antihistone antibodies.
- Symptoms significantly improved within days of hydralazine cessation and initiation of steroid therapy.
Findings:
- A clinical diagnosis of hydralazine-induced lupus (HIL) with pneumonitis was established.
- Genetic testing identified the patient as an intermediate acetylator for N-acetyltransferase 2 (NAT2).
- Complete resolution of pulmonary infiltrates was observed on follow-up chest CT.
Implications:
- Clinicians should consider HIL in patients presenting with lupus-like symptoms and unexplained pneumonitis, especially when exposed to hydralazine.
- Low-dose HIL can occur, particularly in individuals with specific genetic profiles like intermediate or slow NAT2 acetylation.
- Early recognition and drug withdrawal are crucial for favorable outcomes in HIL-associated pneumonitis.
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