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Pathology · Autoimmunity: drug-induced lupus
Sample itemA 60-year-old man who has taken hydralazine for hypertension for 8 months develops arthralgia, fever and pleuritic chest pain. Renal and central nervous system functions are normal. Which antibody is most characteristic?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
D. Anti-histone antibody
Hydralazine, procainamide and isoniazid can cause drug-induced lupus, which is typically mild with arthritis, serositis and fever, and with sparing of kidney and brain. Anti-histone antibodies are present in most cases, while anti-dsDNA and anti-Smith are usually absent. The syndrome resolves on stopping the drug.
Option by option
A. Anti-Ro antibody
Anti-Ro is associated with Sjogren syndrome, subacute cutaneous lupus and neonatal lupus.
B. Anti-Smith antibody
Anti-Smith is highly specific for idiopathic SLE.
C. Anti-double-stranded DNA antibody
Anti-dsDNA is typical of idiopathic SLE and is usually absent in drug-induced lupus.
D. Anti-histone antibody (correct)
Correct. Anti-histone antibodies are the hallmark of drug-induced lupus.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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