title: Hydralazine-Induced ANCA Vasculitis in the Setting of Acute Clostridium Difficile Infection.
abstract: We report a rare case of Hydralazine-induced ANCA associated glomerulonephritis with alveolar hemorrhage in the setting of acute Clostridium Difficile Infection. A 71-year-old Caucasian woman with hypertension, who was being treated with hydralazine 25 mg twice a day for six years, presented to the hospital with diarrhea, nausea, vomiting and anemia. She had acute kidney injury and urinalysis showed proteinuria, dysmorphic RBCs, and rare RBC cast. She was found to have Clostridium difficile colitis which was successfully treated. She became hypoxemic; CT scan findings showed bilateral pulmonary infiltrates. Broncho-alveolar lavage was consistent with pulmonary hemorrhage. Kidney biopsy revealed focal segmental necrotizing and diffuse crescentic glomerulonephritis, pauci-immune type (ANCA-associated). Hydralazine was discontinued and the patient was treated with corticosteroids, intravenous cyclophosphamide and plasmapheresis. To our knowledge, hydralazine-associated low complement in the setting of C-diff infection has not been previously reported. This is considered a potentially life-threatening condition requiring immediate discontinuation of the offending medication and expedited lifesaving measures. [Full article available at http://rimed.org/rimedicaljournal-2016-11.asp].
authors: Department of Internal Medicine at the Memorial Hospital of Rhode Island, Pawtucket, RI; Warren Alpert Medical School of Brown University.
authors: Somwail
authors: S
authors: Rasla
authors: Department of Internal Medicine at the Memorial Hospital of Rhode Island, Pawtucket, RI; Warren Alpert Medical School of Brown University.
authors: Amr
authors: A
authors: El Meligy
authors: Kent County Hospital, Warwick, RI.
authors: Dragos F
authors: DF
authors: Cucu
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000009:adverse effects; D000959:Antihypertensive Agents / Q000009:adverse effects*; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000150:complications*; D003520:Cyclophosphamide / Q000627:therapeutic use; D004761:Enterocolitis, Pseudomembranous; D005260:Female; D005921:Glomerulonephritis / Q000139:chemically induced* / Q000188:drug therapy; D006470:Hemorrhage / Q000139:chemically induced* / Q000188:drug therapy; D006801:Humans; D006830:Hydralazine / Q000009:adverse effects*; D006973:Hypertension / Q000188:drug therapy; D007668:Kidney / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014657:Vasculitis / Q000139:chemically induced* / Q000188:drug therapy
chemical_list: D000305:Adrenal Cortex Hormones; D019268:Antibodies, Antineutrophil Cytoplasmic; D000959:Antihypertensive Agents; D006830:Hydralazine; D003520:Cyclophosphamide
keywords: ANCA Vasculitis; Clostridium Difficile; Hydralazine