When Infection Mimics Vasculitis: Hydralazine-Induced ANCA-Associated Crescentic Glomerulonephritis in the Setting of Active Infective Endocarditis.
Mohmmed Saleh, Shahrzad Zavoshi, Paul Fozo
✦ AI-curated · Sources linked
Case in brief
A 58-year-old man with a history of bicuspid aortic valve presented with fatigue, anemia, and acute kidney injury. He was diagnosed with subacute infective endocarditis after blood cultures grew Streptococcus mutans. Despite antimicrobial treatment, renal dysfunction persisted. A renal biopsy revealed pauci-immune crescentic glomerulonephritis, leading to the diagnosis of hydralazine-induced ANCA-associated vasculitis. After discontinuing hydralazine and initiating corticosteroids, the patient underwent successful aortic valve replacement and stabilized renal function.
Diagnostic / clinical pearl
Persistent renal dysfunction in patients with infective endocarditis, especially with ANCA positivity and chronic hydralazine use, may indicate hydralazine-induced ANCA-associated vasculitis rather than infection-related glomerulonephritis.