PMID- 31497427
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20201001
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 11
IP  - 6
DP  - 2019 Jun 25
TI  - Clinical Characteristics of Hydralazine-induced Lupus.
PG  - e4996
LID - 10.7759/cureus.4996 [doi]
LID - e4996
AB  - Introduction The use of hydralazine has been associated with the development of 
      lupus erythematosus and lupus-like syndromes. We performed this retrospective 
      study to identify clinical characteristics of individuals who developed 
      hydralazine-induced lupus. Material and methods We performed a single-center 
      retrospective review of seven individuals who had a diagnosis of 
      hydralazine-induced lupus by International Classification of Diseases, Ninth 
      Revision (ICD9) code and were on hydralazine prior to their diagnosis. Clinical 
      and laboratory data were obtained from a review of the medical record up to 
      12-month follow-up. Results Of the seven individuals with hydralazine-induced 
      lupus, five were Caucasian (71%) and two were African-American. The mean age at 
      the time of diagnosis was 62 years. Four (57%) were male. The majority of 
      individuals were exposed to hydralazine for more than 12 months (83%). Four 
      individuals had biopsy-proven lupus nephritis and four individuals had 
      cardiopulmonary and skin involvement. Six patients were positive for antinuclear 
      antibody (ANA) with a homogenous pattern, and five of those were positive for 
      anti-histone antibody. Additionally, positive 
      anti-double-stranded DNA (anti-dsDNA) antibody, anti-cardiolipin antibodies, low 
      complements, positive lupus anticoagulant, and leukopenia were seen in 42% of our 
      cohort. Of the five individuals in whom anti-myeloperoxidase (MPO) antibody was 
      strongly positive, all had renal involvement defined by an elevated creatinine 
      with three having biopsy-proven lupus nephritis. Three other individuals with MPO 
      positivity had concurrent cardiopulmonary and skin involvement. Four individuals 
      were positive for anti-proteinase 3 (PR3) antibody, three of whom were strongly 
      positive with renal involvement defined by an elevated creatinine with two having 
      biopsy-proven lupus nephritis. The level of anti-dsDNA antibody and anti-PR3 
      antibody normalized at three months while anti-MPO antibody took 12 months to 
      normalize following cessation of hydralazine. When checked, low complement 
      component 3 (C3) and anti-histone antibody persisted past 12 months. In addition 
      to the withdrawal of hydralazine, six individuals were treated with 
      hydroxychloroquine and five with mycophenolate mofetil. Three of four individuals 
      with renal involvement received plasmapheresis and two received cyclophosphamide 
      and hemodialysis. Conclusion Hydralazine can aggravate and unmask incipient 
      lupus. Since the presentation can be varied, early recognition of symptoms is 
      critical. Precautions should be taken before initiating this medication in 
      individuals with certain risk factors. Once diagnosed, potential serological 
      findings such as a positive anti-MPO/anti-PR3 antibody could predict more severe 
      manifestations such as pulmonary-renal complications.
FAU - Timlin, Homa
AU  - Timlin H
AD  - Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, USA.
FAU - Wu, Michael
AU  - Wu M
AD  - Medicine, The Johns Hopkins University School of Medicine, Baltimore, USA.
FAU - Crespo-Bosque, Monica
AU  - Crespo-Bosque M
AD  - Medicine, The Johns Hopkins University School of Medicine, Baltimore, USA.
FAU - Geetha, Duvuru
AU  - Geetha D
AD  - Medicine, The Johns Hopkins University School of Medicine, Baltimore, USA.
FAU - Ingolia, Ashley
AU  - Ingolia A
AD  - Internal Medicine, North Oaks Health System, Hammond, USA.
FAU - Haque, Uzma
AU  - Haque U
AD  - Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, USA.
FAU - Towns, Marilyn C
AU  - Towns MC
AD  - Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, USA.
FAU - Grader-Beck, Thomas
AU  - Grader-Beck T
AD  - Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, USA.
LA  - eng
PT  - Journal Article
DEP - 20190625
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC6707822
OTO - NOTNLM
OT  - drug induce lupus
OT  - drug-induced lupus
OT  - hydralazine
OT  - hydralazine induced lupus
OT  - lupus
OT  - systemic lupus erythematosus (sle)
COIS- The authors have declared financial relationships, which are detailed in the next 
      section.
EDAT- 2019/09/10 06:00
MHDA- 2019/09/10 06:01
PMCR- 2019/06/25
CRDT- 2019/09/10 06:00
PHST- 2019/09/10 06:00 [entrez]
PHST- 2019/09/10 06:00 [pubmed]
PHST- 2019/09/10 06:01 [medline]
PHST- 2019/06/25 00:00 [pmc-release]
AID - 10.7759/cureus.4996 [doi]
PST - epublish
SO  - Cureus. 2019 Jun 25;11(6):e4996. doi: 10.7759/cureus.4996.