TABLE 1 : Laboratory Values
Normal Reference Case 1 Case 2 Hemoglobin ( g / dL ) 12-15 6.9 6.4 Blood Urea Nitrogen ( mg / dL ) 7-25 32 40 Creatinine ( mg / dL ) 0.6-1.2 3.0 ( baseline 1.6 ) 2.7 ( baseline 2.0 ) Erythrocyte Sedimentation Rate ( mm / hour ) < 20 > 145 101 C-reactive Protein ( mg / L ) < 6 147.4 122.4 p-ANCA < 1:20 Negative 1:640 c-ANCA < 1:20 Negative Negative Anti-Myeloperoxidase < 0.4 7.2 units > 8.0 units Anti-Proteinase 3 < 0.4 Negative Negative Antinuclear Antibody Negative Negative 1:2560 in a homogenous pattern Anti-Double Stranded DNA < 1:10 1:80 Negative Anti-Histone Antibody < 1.0 Not done 2.2 units Glomerular Basement Membrane IgG Antibody < 1.0 Negative Negative C3 Complement ( mg / dL ) 90-180 99 81 C4 Complement ( mg / dL ) 10-40 18 12 Urine RBCs ( per HPF ) < 3 > 182 117
c-ANCA : Cytoplasmic anti-neutrophil cytoplasmic antibody ; p-ANCA : Perinuclear anti-neutrophil cytoplasmic antibody ; HPF : High power field ; IgG : Immunoglobulin G ; RBCs : Red blood cells
FIGURE 1
Case 1 : Chest radiograph ( A ) and CT of the chest ( B ) showing bilateral patchy airspace opacities ( arrowheads ) and a right sided pleural effusion ( arrow ).
Case 2 : Chest radiograph ( C ) and CT of the chest ( D ) showing bilateral airspace opacities ( arrowheads ), left greater than right .
A
C
B
D
propylthiouracil being the two most commonly implicated agents . 2-4 Multiple medications have been associated with autoimmunity but proving causality is difficult . Evidence implicating hydralazine as the causative factor in our two patients includes prior reported cases , temporal relationship , positive anti-histone antibody , and lack of other medications or conditions associated with ANCA-associated vasculitis .
Hydralazine is a potent vasodilator that has been used to treat hypertension since 1951 and more recently in combination with nitrates for heart failure . 5-7 Hydralazine use in the United States has remarkably increased during the decade from 2009-2019 . 8 West Virginia has also
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