C42-21 From Hypertension to Hypersensitivity: A Case of Hydralazine-induced Lupus

Abstract Introduction Drug induced autoimmunity (DIA) refers to an immune mediated disease process begins after a drug is initiated and resolves after the offensive agent is discontinued. We present an interesting case of renal failure and pneumonitis attributed to hydralazine induced lupus. Case Presentation 86 years old Male with history of chronic kidney disease (Stage IIIa), Hypertension, benign prostatic hyperplasia, chronic anemia, gastroesophageal reflux disease presented for abnormal laboratory results, particularly elevated creatinine. patient was started recently on hydralazine for hypertension. Patient was admitted on medical floor for acute on chronic kidney disease. Nephrology was consulted and patient had extensive work-up sent. patient also noted to have cutaneous rash with vesicles noted which was present few weeks prior to presentation. On medical floor his renal function was gradually worsening. Rapid response team was activated for respiratory failure and patient was admitted to the intensive care unit. Chest x ray showed bilateral patchy infiltrates which were initially attributed to pulmonary edema secondary to renal failure. Patient ANA and Anti-DNA antibodies came positive. In ICU patient had dialysis catheter placed and had emergent session of dialysis. Patient was also started on pulse dose steroids 1gram of solumedrol for 3 days along with mycophenolate mofetil. Given persistent hypoxia despite dialysis patient had CT Chest done which showed multifocal bilateral groundglass opacities with mosaic attenuation. Patient also underwent renal biopsy which showed severe interstitial fibrosis and tubular atrophy. Given clinical status unable to do bronchoscopy as patient needed to be intubated. Anti-Histone antibody also came positive strongly suggestive of hydralazine induced renal failure and pneumonitis. Patient clinical status improved with frequent sessions of hemodialysis along with pulse dose steroids and oxygen was weaned off to nasal cannula. Patient infectious workup was also negative during hospitalization. Patient was transferred to medical floor. Patient had tunneled dialysis catheter placed and was discharged on steroid taper to follow up with nephrology and rheumatology as outpatient. Discussion This case highlights the importance of timely recognition and management of drug induced autoimmune conditions as here hydralazine induced lupus. Hydralazine induced lupus has been well reported in literature with an incidence of around 6%. The patient’s presentation with acute kidney injury, positive autoantibodies, and improvement of symptoms with steroids. This abstract is funded by: None