Abstract: FR-PO0942
Not All That Glitters Is Systemic Lupus Erythematosus (SLE): Hydralazine-Induced Lupus with a Twist of Hydroxychloroquine Toxicity
Session Information
- Glomerular Case Reports: Lupus, FSGS, Complement, and More
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Kumar, Anand, The University of Texas Medical Branch at Galveston, Galveston, Texas, United States
- Victory Brodman, Melissa, The University of Texas Medical Branch at Galveston, Galveston, Texas, United States
- Abdul Jabbar, Layla, The University of Texas Medical Branch at Galveston, Galveston, Texas, United States
- Bilal, Ali M, The University of Texas Medical Branch at Galveston, Galveston, Texas, United States
- Sweet, Patrick D, The University of Texas Medical Branch at Galveston, Galveston, Texas, United States
Introduction
Drug-induced lupus nephritis is a rare but recognized complication of prolonged hydralazine use. Coexisting findings of hydroxychloroquine (HCQ) toxicity can confound diagnosis, particularly in elderly patients with multiple comorbidities. We report a case highlighting the diagnostic complexity of lupus nephritis in the setting of medication-induced autoimmunity and pathology
Case Description
A 73-year-old male with HTN, CKD, DM2, seronegative RA on HCQ and Hydralazine presented with fever, cough & dyspnea. He was diagnosed with community-acquired pneumonia and developed septic shock and hypoxic respiratory failure, requiring ICU care. Sputum grew P. aeruginosa; cefepime was started. He stabilized but developed oliguric AKI. Urinalysis showed nephrotic-range proteinuria (>10 g/g UPCR). Labs revealed ANA >1:1280, low C3/C4, p-ANCA+, anti-histone+, indeterminate anti-dsDNA, and negative infectious serologies. Renal biopsy showed Class V lupus nephritis with mesangial expansion, glomerular collapse & tubular injury. IF showed C3, IgG, IgM & Lambda deposits. EM revealed tubulo-reticular inclusions & zebra bodies, consistent with HCQ toxicity. Fabry disease was excluded. Treated with discontinued Hydralazine, Corticosteroids & mycophenolate, Renal function improved.
Discussion
The patient’s nephrotic syndrome was attributed to hydralazine-induced lupus nephritis, supported by positive anti-histone antibodies and chronic hydralazine use. Zebra bodies, linked to hydroxychloroquine toxicity or Fabry disease, were seen but deemed incidental. Diagnostic complexity arose from overlapping drug effects, CKD & systemic symptoms. This case highlights the importance of detailed medication history & histologic evaluation in differentiating primary autoimmune disease from drug-induced pathology.