Which antihypertensive can cause lupus-like syndrome and pericarditis?

• A. Hydralazine
• B. Minoxidil
• C. ACE inhibitors
• D. Spironolactone

Answer: (A)

Hydralazine is known for causing drug-induced lupus erythematosus with serositis, including pericarditis. The drug can provoke autoantibody formation, especially antihistone antibodies, more commonly in slow acetylators. This leads to lupus-like symptoms such as fever, arthralgias, and inflammation of the serosal membranes, producing pericarditis. Unlike true systemic lupus, anti-dsDNA is usually absent, and symptoms improve after stopping the drug, often within weeks. The risk increases with higher doses and with certain drug interactions. Other antihypertensives listed don’t typically cause this lupus-like syndrome or pericarditis.