Discussion: Specific drugs are known to induce an autoimmune response with the production of autoantibodies. Common drugs known to induce lupus include sulfasalazine, hydralazine, isoniazid, procainamide, and penicillamine (which are easily remembered by the mnemonic “SHIPP”). Drug-induced lupus is diagnosed when clinical features consistent with systemic lupus erythematosus are evident and autoimmune antibodies are present in the serum. In our patient, she did not exhibit signs of myalgia, arthralgia, or rash, but rather pulmonary manifestations (i.e., diffuse alveolar hemorrhage). Anti-histone antibodies have been shown to be present in 95-percent of patients with hdyralazine-induced lupus. Furthermore, p-ANCA antibodies have been shown to be markedly elevated in cases of hydralazine-induced vasculitis. In such cases, typical management involves complete withdrawal of hydralazine and administration of immunosuppressive therapy, as demonstrated above with this patient.
Conclusions: Drug-induced lupus can be challenging to hospitalists. In essence, this case illustrates the importance of taking a thorough medication history and being cognizant of medication side effects. Furthermore, if this diagnosis is suspected, autoimmune antibodies should be collected and results should be correlated with the patient’s clinical presentation.
To cite this abstract:Avila, JC II . OH SHIPP!. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 339. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/oh-shipp/. Accessed September 19, 2019.