An 87-year-old man with progressive acute kidney injury and diffuse alveolar hemorrhage

This is the authors' abstract. We don't add key points for this paper.

Drug-induced ANCA associated vasculitis is a rare complication that can present with pulmonary renal syndrome. Here, we present the case of an 87-year-old man with chronic kidney disease and recent hydralazine dose increase who developed hemoptysis, acute kidney injury and new pulmonary infiltrates. Blood testing revealed elevated anti-MPO and anti-histone antibody titers. Renal biopsy showed a pauci-immune necrotizing glomerulonephritis. Overall, his clinical presentation was most in keeping with drug-induced ANCA associated vasculitis. Hydralazine was discontinued and immunosuppressive therapy was started, which led to clinical remission. Drug-induced ANCA associated vasculitis should be considered in patients presenting with pulmonary renal syndrome and exposure to common culprit medications. Early recognition and withdrawal of the offending medication are key to management.