minocycline and Alveolitis--Extrinsic-Allergic

Topics: Acne Vulgaris; Adult; Alveolitis, Extrinsic Allergic; Female; Humans; Minocycline; Radiography

Topics: Adult; Alveolitis, Extrinsic Allergic; Anti-Bacterial Agents; Central Nervous System Diseases; Female; Humans; Minocycline

We studied the clinical features of minocycline-induced pneumonitis in seven patients. Acute symptoms included fever, dry cough and dyspnea, indicating acute respiratory failure. Diffuse ground glass shadows with Kerley's B lines, bronchial wall thickening, swelling of vascular bundles and pleural effusion were visible on radiography. Bronchoalveolar lavage or transbronchial lung biopsy confirmed pulmonary eosinophilia. Cessation of minocycline led to rapid remission with no treatment or only short-term steroid therapy. The lymphocyte stimulation test for minocycline with peripheral blood lymphocytes was not found to be useful for diagnosis.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Alveolitis, Extrinsic Allergic; Anti-Bacterial Agents; Biopsy; Blood Gas Analysis; Bronchoalveolar Lavage; Bronchoalveolar Lavage Fluid; C-Reactive Protein; Female; Humans; Immunoglobulin E; Leukocyte Count; Male; Minocycline; Pharyngitis; Pulmonary Eosinophilia; Tomography, X-Ray Computed

Topics: Adult; Alveolitis, Extrinsic Allergic; Humans; Male; Minocycline; Prednisolone; Tomography, X-Ray Computed

A patient is reported who developed dyspnoea, fever, pleuritic chest pain and a non-productive cough following treatment with minocycline for 9 days. The chest radiograph showed an interstitial pattern and there was a peripheral eosinophilia. A diagnosis of hypersensitivity pneumonitis attributable to minocycline was made. The disease responded quickly to withdrawal of the drug. This observation shows that minocycline, despite its mild toxicity profile, can give rise to serious adverse effects.

Topics: Alveolitis, Extrinsic Allergic; Drug Hypersensitivity; Female; Humans; Middle Aged; Minocycline

To identify the cause of a hypersensitivity pneumonitis and to determine its pathogenesis.. Case study.. Intensive care unit of a referral hospital.. A 51-year-old man with chronic bronchitis who developed a hypersensitivity pneumonitis within 1 month after exposure to minocycline, amoxicillin, and erythromycin.. Sequential bronchoalveolar lavages after reexposure to minocycline and amoxicillin.. Immunologic analysis of the phenotype and function of alveolar lymphocytes.. Reexposure to minocycline but not to amoxicillin was followed by an interstitial pneumonitis. Sequential bronchoalveolar lavages showed a transient rise of eosinophils and neutrophils and a persistent alveolar lymphocytosis. Alveolar lymphocytes consisted predominantly of CD8+ but also CD4+ cells. Two CD8+ lymphocyte subsets were identified: CD8+ D44+ cytotoxic T cells that increased rapidly after the drug was resumed and CD8+ CD57+ suppressor T cells that predominated 11 days after the drug's withdrawal. In-vitro assays showed the presence of a lymphocyte-mediated specific cytotoxicity against minocycline-bearing alveolar macrophages.. These results support the hypothesis of a central role of T lymphocytes in the pathogenesis of drug-related hypersensitivity pneumonitis.

Topics: Alveolitis, Extrinsic Allergic; Bronchoalveolar Lavage Fluid; Cytotoxicity, Immunologic; Drug Hypersensitivity; Humans; Immunity, Cellular; Immunophenotyping; Leukocyte Count; Macrophages, Alveolar; Male; Middle Aged; Minocycline; Pulmonary Alveoli; T-Lymphocytes