Hydralazine-Induced Vasculitis Resulting in Large Pleural Effusion and Progressive Renal Dysfunction

Hydralazine is a vasodilator commonly used to treat high blood pressure. Even with the safety profile of Hydralazine, it is necessary to know that it may lead to Hydralazine-Induced Vasculitis. Here, we discuss how this rare side effect can present in an 80-year-old female with a past medical history of hypertension who presented to the emergency department with complaints of progressive shortness of breath on exertion and while lying supine. Further evaluation revealed a large right-sided pleural effusion with consolidation at the right lower lobe. The patient’s dyspnea worsened, and the surgical team placed a chest tube. The patient also experienced deteriorating kidney function and was noted to have proteinuria. Further workup revealed elevated Proteinase 3 (PR3), Myeloperoxidase (MPO), and anti-histone antibodies. A renal biopsy showed moderate interstitial fibrosis and 22% globally sclerosed glomeruli, leading to the diagnosis of Hydralazine-induced ANCA vasculitis.