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2017 ; 2017
(ä): 2650142
Nephropedia Template TP
Case Rep Pulmonol
2017[]; 2017
(ä): 2650142
PMID28932614
show ga
A 35-year-old female was started on hydralazine 10?mg orally three times a day
for treatment of postpartum hypertension. Three months later, after multiple
unsuccessful courses of prednisone and antibiotics for presumed pneumonia and
asthma exacerbations, her respiratory symptoms progressed in severity and she
developed resting hypoxia. Previous diagnostic work-up included spirometry with a
restrictive pattern, chest CT showing bilateral basilar consolidation, negative
BAL, and nonspecific findings on lung biopsy of mild inflammatory cells. Review
of systems was positive for arthralgia, lymphadenopathy, paresthesia, and fatigue
that began four weeks after starting hydralazine. A clinical diagnosis of
hydralazine-induced lupus (HIL) with pneumonitis was made. Antihistone antibodies
were positive supporting a diagnosis of HIL. Management included cessation of
hydralazine and a prolonged steroid taper. Within days, patient began improving
symptomatically. Six weeks later, CT chest showed complete resolution of
infiltrates. Genetic testing revealed she was heterozygous for
N-acetyltransferase 2 (intermediate acetylator). Drug-induced lupus should be
considered in patients with lupus-like symptoms taking medications with a known
association. While the majority of HIL cases occur with high doses and prolonged
treatment, cases of low-dose HIL have been reported in patients who are slow
acetylators.