Combined ANCA-associated vasculitis and lupus syndrome following prolonged use of hydralazine: a timely reminder of an old foe

Excerpt

A 55-year-old woman with type II diabetes and resistant hypertension presented to her GP in July 2008 complaining of lethargy, breathlessness, and joint pains. In 2007, based upon a positive antinuclear antibody test (ANA) in the context of pancytopenia, arthralgia, and a persistent malar rash, she had been diagnosed with systemic lupus erythematosis (SLE) by her referring hospital. Her regular medications were perindopril 4 mg daily, amlodipine 5 mg daily, atenolol 100 mg daily, and hydralazine 25 mg twice daily which she had started in 2005. She had remained on hydralazine, despite the diagnosis of SLE, treatment of which was limited to intra-articular corticosteroid injections. In July 2008 she was referred to our renal unit with acute kidney injury (AKI).

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