Hydralazine can cause interstitial lung disease, pauci-immune glomerulonephritis and hypocomplementemia. Hydralazine- induced ANCA- associated vasculitis and hydralazine-induced lupus are rare. We describe a case of hydralazine-associated vasculitis with rapidly progressive glomerulonephritis and highlight the importance of early diagnosis and treatment as it can be rapidly progressive and fatal.