Abstract
Hydralazine has been used for decades for the management of hypertension. However, hydralazine has been associated with various side effects, including autoimmune diseases such as hydralazine-induced antineutrophil cytoplasmic antibody-associated vasculitis (ANCA-vasculitis) and lupus-like syndrome characterized by multiorgan involvement and complex clinical manifestations. We present four cases of hydralazine-induced vasculitis (sometimes referred to as drug-induced lupus or DIL) with different presentations, including diffuse alveolar hemorrhage, hemoptysis, and skin rash. Based on variable manifestations, diagnosis can be difficult, and a high index of suspicion is of paramount importance. The final diagnosis is made by kidney biopsy, and treatment includes discontinuation of the offending agent and frequent immunosuppression. We urge caution with the use of hydralazine and choosing alternative antihypertensives when possible.