Hydralazine, an arterial vasodilator, is a widely used medication for the management of hypertension and
heart failure, especially for patients who cannot tolerate the use of ACEIs or ARBs. It is generally well
tolerated and has safe profile in pregnancy. However, hydralazine can induce immune mediated side effects,
such as hydralazine-induced lupus and less commonly hydralazine-induced ANCA vasculitis.
2 The latter
most commonly affects the kidneys with or without other organ involvement. There are several cases
reported in the literature of hydralazine-induced ANCA associated vasculitis (AAV) that have pulmonary
manifestations, also known as hydralazine-induced pulmonary-renal syndrome (PRS), a condition with
high risk of mortality. We are reporting a case of Hydralazine-induced ANCA associated
glomerulonephritis with severe diffuse alveolar hemorrhage (DAH). In addition, we will review the current
literature and discuss the importance of prompt diagnosis and early management to decrease mortality and
morbidity associated with this serious condition.
Keywords: Hydralazine, vasculitis, pulmonary hemorrhage, hypertension, heart failure.
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