Key result
Hydralazine exposure induces ANCA-associated serositis causing massive pericardial effusion and cardiac tamponade.
Why the study?
Drug-induced pericardial effusion is an uncommon cause of cardiac tamponade, and hydralazine-associated cardiovascular manifestations remain under-recognized.
Case Report (n=1)
This case highlights hydralazine as a potentially reversible cause of autoimmune-mediated massive pericardial effusion and illustrates that cardiac tamponade can manifest with preserved blood pressure.
Prompts hydralazine screening in normotensive tamponade with autoimmune serology; case report leaves incidence and causality open.
BACKGROUND: Drug-induced pericardial effusion is an uncommon but clinically significant cause of cardiac tamponade. Hydralazine is strongly associated with autoimmune phenomena, yet cardiovascular manifestations remain under-recognized. CASE SUMMARY: A 42-year-old man receiving high-dose hydralazine presented with progressive dyspnea, dizziness, and palpitations. Transthoracic echocardiography demonstrated a large circumferential pericardial effusion with right ventricular diastolic collapse and a plethoric inferior vena cava, consistent with tamponade physiology despite preserved blood pressure. Emergent pericardiocentesis drained 1,860 mL of serosanguinous exudative fluid, with immediate symptom relief. Serologic testing revealed antinuclear antibody positivity, markedly elevated perinuclear antineutrophil cytoplasmic antibodies, and borderline myeloperoxidase antibodies. Hydralazine withdrawal and corticosteroid therapy resulted in sustained clinical and echocardiographic resolution. DISCUSSION: This case highlights hydralazine as a reversible cause of autoimmune-mediated pericardial effusion and illustrates that tamponade may occur without hypotension. TAKE-HOME MESSAGES: Medication-induced autoimmunity should be considered in unexplained pericardial effusions. Early recognition and drug withdrawal can prevent life-threatening complications.
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AKELE et al. (2026) conducted a case report in Pericardial effusion with cardiac tamponade (n=1). Hydralazine was evaluated. Hydralazine exposure induced ANCA-associated autoimmune serositis leading to a massive pericardial effusion and cardiac tamponade without hypotension, which resolved entirely upon drug withdrawal and pericardial drainage.
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