Hydralazine-Induced Antineutrophil Cytoplasmic Antibody Vasculitis Causing Gastroduodenal Artery Perforation

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides are rare disorders characterized by inflammation of small blood vessels, including capillaries, venules, and arterioles. The three main subtypes of primary ANCA-associated vasculitides (i.e., granulomatosis with polyangiitis, microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis) can present with diverse and nonspecific symptoms, making diagnosis difficult. We report the case of secondary, drug-induced ANCA vasculitis in a female patient who presented with hemoptysis and dyspnea complicated by acute kidney injury and severe anemia. Serologic testing and renal biopsy confirmed the diagnosis of ANCA-associated vasculitis (AAV). Her hospital course was complicated by multiple gastrointestinal bleeds requiring two interventional radiology procedures, first on her gastroduodenal artery and later on her inferior pancreaticoduodenal artery. The patient was treated with cyclophosphamide and plasma exchange during hospitalization and was transitioned to rituximab and intravenous steroids, resulting in an eventual recovery. This case highlights the intricacies of diagnosing AAV and the potential severe, life-threatening complications, such as gastrointestinal hemorrhage. Early recognition and a multidisciplinary approach are critical to evaluate and treat as well as to improve outcomes in patients with this rare but serious condition.