Antigen specificity in hydralazine associated ANCA positive systemic vasculitis

The anti-hypertensive agent hydralazine can cause a lupus-likesyndrome characterized by serosal inflammation, arthralgiasand rashes. The kidneys however are usually spared. The conditionis characterized by circulating immune complexes and antinuclearantibodies, whilst antibodies against doublestranded DNA arerare. Hydralazine can also cause a systemic vasculitis witha pauci-immune rapidly progressive glomerulonephritis, whichis associated with autoantibodies directed against componentsof the neutrophil cytoplasm. In this study, ten patients withhydralazine-induced vasculitis had antibodies with specificitiesfor both myeloperoxidase and lactoferrin. We suggest that thisparticular pattern of autoantibodies, together with antibodieswith reactivity against nuclear components including double-strandedDNA, are characteristic findings in hydralazine-induced vasculitis.In addition, renal involvement appears to be more common inthis group of patients with vasculitis than in those with thelupus-like syndrome.