Hydralazine-Induced ANCA-Associated Vasculitis: Case Report with Severe Kidney Involvement

ANCA-associated vasculitis is a serious and fatal condition that frequently presents with severe kidney involvement. Drugs that can induce ANCA-associated systemic vasculitis include antithyroid agents, cocaine/levamisole, minocycline, and hydralazine. Recognizing drugs associated with systemic vasculitis is extremely important for clinicians, as they can prescribe them with caution. Furthermore, it is essential to suspect and diagnose this complication when it appears, as it is a serious but preventable condition. ANCA-associated vasculitis induced by drugs tends to present with systemic, kidney, and pulmonary involvement. It is characterized by positivity to multiple autoantibodies, especially p-ANCA, anti-PR3, anti-MPO, anti-histone, ANA, and antiphospholipid antibodies; in addition to normal complement. Treatment consists of discontinuing the causative drug and systemic immunosuppression if the condition is severe. We present the case of a patient with hydralazine-induced ANCA-associated vasculitis who presented with rapidly progressive glomerulonephritis and severe anemia. Her clinical presentation, differential diagnosis, serological and histopathological studies are described. In addition, the patient's evolution and favorable response to induction treatment with corticosteroids plus cyclophosphamide are detailed.