背景:我们介绍了一例低剂量肼屈嗪继发的药物性血管炎,具有抗中性粒细胞胞浆抗体相关血管炎和药物性狼疮性肾炎的重叠特征。
方法:一名52岁的西班牙裔女性,有顽固性高血压病史,每天两次服用10毫克肼屈嗪治疗1年,表现为全身无力,头晕,恶心,呕吐,和肉眼血尿.发烧了,心动过速,白细胞增多,乳酸性酸中毒,高钾血症,肾功能衰竭,和贫血。胸部计算机断层扫描和支气管镜检查显示左下叶浸润和弥漫性肺泡出血。抗双链DNA血清学检测呈阳性,反史密斯,狼疮抗凝药,抗组蛋白,抗心磷脂IgM抗体,和抗中性粒细胞胞浆抗体(髓过氧化物酶和蛋白酶3)。肾脏活检显示新月体肾小球肾炎与膜性肾病重叠。广谱抗生素,免疫抑制剂,皮质类固醇,并开始血浆置换。患者存活,但需要持续血液透析。
结论:尽管已经报道了一些同时发生的抗体相关性血管炎和继发于肼屈嗪的药物诱导的狼疮性肾炎的病例,这个案例是奇异的。先前报道了类似的发现,在1-5年内每天2-3次,剂量为50-100毫克。在我们的病人身上,每天两次的剂量仅10毫克,持续一年会导致严重的疾病表现。这揭示了可以共存的不同血管炎的组合以及低剂量肼屈嗪的潜在威胁生命的不利影响,这一点应牢记。
BACKGROUND: We present a case of drug-induced vasculitis secondary to low-dose hydralazine with overlapping features of antineutrophil cytoplasmic antibody-associated vasculitis and drug-induced lupus nephritis.
METHODS: A 52-year-old Hispanic woman with a medical history of resistant hypertension treated with hydralazine 10 mg twice daily for 1 year presented with generalized weakness, dizziness, nausea, vomiting, and gross hematuria. There was fever, tachycardia, leukocytosis, lactic acidosis, hyperkalemia, renal failure, and anemia. Chest computed tomography and bronchoscopy revealed a left lower lobe infiltrate and diffuse alveolar hemorrhage. Serologic testing was positive for anti-double-stranded DNA, anti-Smith, lupus anticoagulant, anti-histone, anti-cardiolipin IgM antibodies, and antineutrophil cytoplasmic antibodies (myeloperoxidase and proteinase 3). A kidney biopsy revealed crescentic glomerulonephritis with an overlapping finding of membranous nephropathy. Broad-spectrum antibiotics, immunosuppressants, corticosteroids, and plasmapheresis were initiated. The patient survived but required continuous hemodialysis.
CONCLUSIONS: Although a few cases of simultaneous antibody-associated vasculitis and drug-induced lupus nephritis secondary to hydralazine use have been reported, this case is singular. Similar findings were previously reported with doses of 50-100 mg two to three times daily over 1-5 years. In our patient, a dose of only 10 mg twice daily for a year caused a severe disease presentation. This brings to light the combination of different vasculitides that can coexist and the potentially life-threatening adverse effects of low-dose hydralazine that should be kept in mind.