The Drug-Induced Respiratory Disease Website

Hydralazine

Dual MPO-/PR3-ANCA systemic disease/vasculitis or pseudovasculitis

Bhatnagar M, Agaronov A, Sarkisyan E, Sotoudeh Deilamy I, Pepito D, Akhondi H

Overlapping drug-induced vasculitis, ANCA-associated vasculitis, and lupus nephritis caused by low-dose hydralazine.

International journal of rheumatic diseases 2023 Jul 14;; — 2023 Jul 14

Padala SA, Medepalli VM, Mohammed A, Nahman S

Hydralazine-Induced Dual Antineutrophil Cytoplasmic Antibody Positive Vasculitis and Nephritis.

Cureus 2020 Jun 29;12;e8911 — 2020 Jun 29 — e8911

Agarwal G, Sultan G, Werner SL, Hura C

Hydralazine induces myeloperoxidase and proteinase 3 anti-neutrophil cytoplasmic antibody vasculitis and leads to pulmonary renal syndrome.

Case reports in nephrology 2014;2014;868590 — 2014 — 868590

Diagnosing DIRD

Drug and radiation history

Drug singularity - Correct identification of the drug

Consistent timing of exposure v. onset of symptoms

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

Careful exlusion of another cause

Remission of symptoms with removal of drug

Recurrence with rechallenge (rarely advisable)

Causality assessment

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