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• W4387250072 abstract "SESSION TITLE: Critical Care Case Report Posters 18 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: Drug-induced lupus erythematosus (DILE) is a well-known complication of hydralazine that occurs in approximately 5 to 10 percent of patients per year of therapy. It can present with arthralgias, petechiae, myalgias, and a rash; though systemic vasculitis is far rarer and is often associated with ANCA positive DILE. Pericardial effusion occurring 3 weeks after the discontinuation of hydralazine is a rare presenting symptom of DILE and hydralazine-induced pericardial effusion alone is only documented in case reports. CASE PRESENTATION: A 44-year-old man with past medical history of end stage renal disease on hemodialysis, pancytopenia, and recently treated hydralazine-induced lupus vasculitis presented with lower extremity swelling, hypotension, and hypoxia from his hemodialysis session. While obtaining a CT chest, he had a syncopal episode while lying flat with acute hypoxic respiratory distress. At this time, he became altered and was subsequently intubated. Preliminary CT demonstrated a new large pericardial effusion. He was started on norepinephrine and escalated to the intensive care unit. Bedside cardiac ultrasound revealed early tamponade physiology with a D sign. Cardiology completed a pericardiocentesis with pericardial drain placed. Fluid studies revealed an exudative process on light's criteria. After the procedure, the patient was quickly weaned off pressors and extubated. The patient began to develop a papular rash on his fingers, arm, and forehead similar to his prior DILE episode despite cessation of hydralazine and treatment with IV solumedrol three weeks prior. Laboratory studies at that time revealed ANA 1:320 with homogenous pattern, low C3, positive ANCA, and high titer anti-MPO with positive anti-PR3. Biopsy of his rash was suggestive of leukocytoclastic vasculitis. Patient was started on IV solumedrol 1mg/kg for 7-day course. His rash improved, and his pericardial drain output decreased and was removed. DISCUSSION: Up to 10% of lupus cases are drug induced. The most frequent clinical presentations of DILE include arthralgia, arthritis, myalgia, fever, and weight loss. Cutaneous involvement and cardiac tamponade are less common in idiopathic lupus. This case in particular is complicated by the patient's initial symptom improvement with the discontinuation of hydralazine and treatment with IV solumedrol. Then presented with a pericardial effusion with tamponade 3 weeks later. CONCLUSIONS: Hydralazine-induced lupus is a well-known drug reaction and can present with arthralgias, petechiae, myalgias, and a rash. Systemic vasculitis and pericardial effusion caused by hydralazine is rare. In this case, we illustrated a case of steroid resistant lupus vasculitis that was further complicated by exudative pericardial effusion leading to tamponade 3 weeks after drug cessation, indicating the need for further study on this rare disease. REFERENCE #1: Hess, E. (1988). Drug-related lupus. New England Journal of Medicine, 318(22), 1460–1462. https://doi.org/10.1056/nejm198806023182209. REFERENCE #2: Zeitjian V, Mehdizadeh A. ANA-Negative Hydralazine-Induced Pericardial Effusion. Case Rep Med. 2017;2017:3521541. doi: 10.1155/2017/3521541. Epub 2017 Dec 17. PMID: 29391867; PMCID: PMC5748098. REFERENCE #3: Rahman MF, Panezai MA, Szerlip HM. Hydralazine-induced pericardial effusion. Proc (Bayl Univ Med Cent). 2019 Jun 10;32(3):377-378. doi: 10.1080/08998280.2019.1613331. PMID: 31384190; PMCID: PMC6650239. DISCLOSURES: No disclosure on file for Ala Abu Sayf No relevant relationships by Bassem Farah No relevant relationships by Alireza Meysami No relevant relationships by Johnathan Stephan No relevant relationships by Stefani Thompson" @default.
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• W4387250072 date "2023-10-01" @default.
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• W4387250072 title "HYDRALAZINE-INDUCED ANCA-VASCULITIS WITH CARDIAC TAMPONADE" @default.
• W4387250072 doi "https://doi.org/10.1016/j.chest.2023.07.1840" @default.
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