The Journal of the Arkansas Medical Society Med Journal May 2019 Final 2 | Page 11

most severe pulmonary manifestation of DIAV; it
may initially manifest as only a cough and slight
dyspnea. Patients with DIAV may also complain
of chest pain, reflecting pericarditis. Neurologi-
cally, patients may experience nonspecific cognitive
symptoms and sensorineural hearing loss. Finally,
while uncommon, hypocomplementemia predicts a
worse prognosis with more severe organ damage. 10
When either DIL or DIAV are suspected, the di-
agnostic testing should include an ANA titer, antihis-
tone antibody, C3, C4 for DIL, and an ANCA for DIAV.
Furthermore, to assess the extent of the disorder,
the practitioner should order a CBC with differential,
CMP, and urinalysis with microscopy, with additional
tests based on those initial test results. However,
because these laboratory tests are not diagnostic
for DIL or DIAV, an extensive differential diagnosis
list should include infections, malignancies, endo-
crinopathies, and other autoimmune conditions.
The most important therapy/intervention in the
management of DIL or DIAV is discontinuing the
offending drug. Depending on the severity of the
disease manifestations, nonsteroidal anti-inflam-
matory drugs can be used for arthralgias. Patients
with serositis or other significant organ involvement
may require systemic steroids or immunosuppres-
sive agents after a tissue diagnosis.
In our patient, despite discontinuing the hy-
dralazine and treatment with methylprednisolone- 1
gram intravenous/day x 3 days followed by oral pred-
nisone-60 mg/day and rituximab-375 mg/m 2 /week x
4 weeks, she remained dialysis dependent.
CONCLUSION
We conclude that it is important to recognize
the autoimmune adverse effects of hydralazine, es-
pecially in the setting of its increased clinical use.
When patients that have autoimmune disease as a
complication develop new, unexplained symptoms
after starting medications, prompt investigation is
necessary to prevent irreversible end organ damage.
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