The Drug-Induced Respiratory Disease Website

Hydralazine

Alveolar hemorrhage (AH), diffuse AH (DAH)

(Fr: hémorragie alvéolaire pure, isolée, sans auto-Ac). Diffuse bland alveolar hemorrhage (DAH). Can be severe or fatal (PMID 26236607). When unassociated with pulmonary vasculitis or capillaritis, the condition is named bland diffuse alveolar hemorrhage (DAH). Caution: hemosiderin-laden BAL macrophages can be found in DAD (PMID 19129275). Laboratory clues to this condition include ANA, ANCA, platelets and coagulation studies (INR, and full blood count). DAH may unravel thrombocytopenia (that may be drug-induced), coaculopathy, ANA- or ANCA- and, less often, anti-GBM-(drug)-related disease. Pulmonary capillaritis is more often suspected than proved, as the lung biopsy is generally avoided if typical gross BAL features for AH are present. ANCA of MPO-, HNE- or, less often, -PR3 with multispecificity and high titers suggest the drug etiology. Drug-induced DAH can mimic primary ANCA-related micropolyangiitis or 'Wegener's'. See PMID 19592204, 20442117, 21606695, 21674416. A search for underlying pulmonary condition at the origin of hemorrhage (e.g. lung cancer, bronchiectasis) is indicated. See also under IIIb, VId, Xs, Xz, XVIIv. 2018 review @PMID 30404115

Publications

Kim J, Hoque F

Diffuse Alveolar Hemorrhage Linked to Hydralazine.

Journal of Brown hospital medicine 2024;3;32-35 — 2024 — 32-35

Acharya I, Weisman DS, Smith LW, Arend LJ

Diagnostic dilemma: drug-induced vasculitis versus systemic vasculitis.

BMJ case reports 2023 Jul 10;16; — 2023 Jul 10

Khosla AA, Saunders H, Helgeson S, Hikida H, Aslam N, Salem F, Albadri S, Baig H

The Utility of Bronchoscopy in Hydralazine-Induced ANCA-Associated Vasculitis.

Case reports in pulmonology 2023;2023;1461011 — 2023 — 1461011

Alawneh D, Edrees A

Hydralazine-Induced Antineutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis: A Case Report and Literature Review.

Cureus 2022 Apr;14;e24132 — 2022 Apr — e24132

Russe-Russe JR, Pellegrini JR, Alvarez-Betancourt A, Munshi RF, Anand P

Fulminant Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis After 10 Years of Hydralazine Use.

Cureus 2021 Oct;13;e18974 — 2021 Oct — e18974

Battisha A, Doughem K, Sheikh O, Konduru L, Madoukh B, Al-Sadawi M, Shaikh S

Hydralazine-Induced ANCA Associated Vasculitis (AAV) Presenting with Pulmonary-Renal Syndrome (PRS): A Case Report with Literature Review.

Current cardiology reviews 2020 May 17;; — 2020 May 17

Al-Abdouh A, Siyal AM, Seid H, Bekele A, Garcia P

Hydralazine-induced antineutrophil cytoplasmic antibody-associated vasculitis with pulmonary-renal syndrome: a case report.

Journal of medical case reports 2020 Apr 15;14;47 — 2020 Apr 15 — 47

Paley MA, Edrees F, Kudose S, Gaut JP, Ranganathan P, Vijayan A

Successful use of rituximab for hydralazine-induced anti-neutrophil cytoplasmic antibodies-associated vasculitis.

Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia 2019 Jan-Feb;30;226-230 — 2019 Jan-Feb — 226-230

Kalra A, Yokogawa N, Raja H, Palaniswamy C, Desai P, Zanotti-Cavazzoni SL, Rajaram SS

Hydralazine-induced pulmonary-renal syndrome: a case report.

American journal of therapeutics 2012 Jul;19;e136-8 — 2012 Jul — e136-8

Diagnosing DIRD