minocycline and Eosinophilia

We report four cases of the side effects of minocycline seen during the last two years in our department. There was one case of drug-related lupus and three cases of hypersensitivity reactions, including one eosinophilic pneumopathy with pericarditis, one nephropathy and one severe, pseudo-infectious episode of high fever, rash, lympadenopathy, hepatitis and eosinophilia. Minocycline is a tetracycline agent widely used for acne therapy in France and all over the world. During the last few years, there has been an increasing number of reports concerning systemic adverse reactions to minocycline, with on the one hand auto-immune disorders (lupus, autoimmune hepatitis, vascularitis with ANCA), occurring after a prolonged course of therapy and reported recently in the last few years, and on the other hand, hypersensitivity reactions (eosinophilic pneumopathies, hepatitis, nephropathies, myocarditis, serum sickness or pseudo-infectious reactions), occurring precociously in the course of therapy, and potentially severe. Although these side effects are uncommon in the context of the high number of patients who have been prescribed the drug, the first-line antibiotic therapy in acne must probably be reconsidered.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Drug Hypersensitivity; Eosinophilia; Female; Humans; Kidney Diseases; Lung Diseases; Lupus Vulgaris; Male; Minocycline

Topics: Anti-Bacterial Agents; Drug Hypersensitivity Syndrome; Eosinophilia; Humans; Meningitis, Aseptic; Minocycline

Topics: Anti-Bacterial Agents; Biopsy; Combined Modality Therapy; Drug Hypersensitivity Syndrome; Echocardiography; Eosinophilia; Extracorporeal Membrane Oxygenation; Female; Humans; Immunosuppressive Agents; Minocycline; Myocarditis; Myocardium; Necrosis; Recovery of Function; Treatment Outcome; Ventricular Function, Left; Young Adult

Minocycline (MCN) is a member of the tetracycline family that is commonly used to treat dermatologic conditions such as acne and perioral dermatitis; however, it also has been associated with a number of adverse effects, including drug reaction with eosinophilia and systemic symptoms (DRESS). We report the case of a 46-year-old woman who developed a rash, fever, and eosinophilia during treatment with MCN for perioral dermatitis. Although MCN was discontinued and the patient was administered oral corticosteroids for several months, she subsequently died from multiorgan failure with giant cell myocardi-tis (GCM) and eosinophilic myocarditis found on autopsy. This article highlights a rare consequence of hypersensitivity to a commonly used drug and illustrates the importance of rapid recognition and aggressive management of MCN-induced DRESS.

Topics: Anti-Bacterial Agents; Dermatitis, Perioral; Drug Hypersensitivity Syndrome; Eosinophilia; Fatal Outcome; Female; Fever; Giant Cells; Humans; Middle Aged; Minocycline; Myocarditis

Topics: Anti-Bacterial Agents; Eosinophilia; Hepatitis, Autoimmune; Humans; Lupus Erythematosus, Systemic; Minocycline; Nephritis; Pneumonia

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare serious adverse effect associated with a variety of medications. We present a case of minocycline-induced DRESS syndrome, which resulted in acute renal failure, transient thyroiditis, and transaminitis, and a persistent lymphocytic myocarditis resulting in congestive heart failure. To our knowledge, this is the third reported case of minocycline-induced myocarditis. Additionally, we report successful plasmapheresis and rituximab treatment for minocycline-induced myocarditis associated with the DRESS syndrome.

Topics: Acne Vulgaris; Adult; Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Drug Eruptions; Drug Hypersensitivity; Eosinophilia; Female; Humans; Minocycline; Myocarditis; Plasmapheresis; Rituximab

Drug rash, eosinophilia, and systemic symptoms syndrome is a type of drug hypersensitivity reaction characterized by the clinical triad of skin eruption, fever, and internal organ involvement. Drug rash, eosinophilia, and systemic symptoms syndrome has rarely been reported in association with vancomycin or in the pediatric population. There have only been four pediatric case reports of drug rash, eosinophilia, and systemic symptoms syndrome and three cases of drug rash, eosinophilia, and systemic symptoms syndrome involving vancomycin published in the English literature to date.. We describe two pediatric cases of drug rash, eosinophilia, and systemic symptoms syndrome to illustrate the range in severity of presentation. The first case illustrates drug rash, eosinophilia, and systemic symptoms syndrome associated with vancomycin exposure in a 14-yr-old boy with Duchenne muscular dystrophy after posterior spinal fusion, whose clinical presentation was indistinguishable from toxic shock syndrome. The second case illustrates a milder and more typical presentation of drug rash, eosinophilia, and systemic symptoms syndrome in a 14-yr-old boy being treated with minocycline for acne. We also present a review of the literature relevant to this syndrome.. : Drug rash, eosinophilia, and systemic symptoms syndrome is relatively unknown among general pediatricians and pediatric intensivists and may potentially become more common with the increasing use of long-term medications in the pediatric population. Our cases demonstrate the importance of an awareness of drug rash, eosinophilia, and systemic symptoms syndrome among general pediatricians and pediatric intensivists because drug rash, eosinophilia, and systemic symptoms syndrome may present in any range of severity, from indolent illness to frank and refractory shock.

Topics: Adolescent; Anti-Bacterial Agents; Diagnosis, Differential; Drug Hypersensitivity; Eosinophilia; Exanthema; Humans; Male; Minocycline; Severity of Illness Index; Shock, Septic; Syndrome; Vancomycin

Topics: Adrenal Cortex Hormones; Adult; Anti-Bacterial Agents; Eosinophilia; Female; Folliculitis; Histamine Antagonists; HIV Infections; Humans; Minocycline; Mucinosis, Follicular

We describe a 54-year-old man who presented with right subcostal pain. Minocycline had been prescribed to treat pruritus, and the symptoms resolved. Subsequently, the patient consulted a local physician because of right subcostal pain. Giant folds were found in the greater curvature of the gastric body, and he was referred to the Department of Gastroenterology, Kitasato University East Hospital. Upper gastrointestinal endoscopy revealed markedly enlarged folds in the greater curvature of the stomach, with redness and edematous mucosa in the lesser curvature. Biopsy showed marked inflammatory cell infiltration (mainly eosinophils), but no atypical cells. Blood tests showed marked eosinophilia and elevated immunoglobulin E levels in the serum. The results of various allergic examinations were negative, but the clinical course suggested drug-induced eosinophilic gastroenteritis, and treatment was started. Minocycline was withdrawn without adequate resolution of symptoms. Because the leukocyte and eosinophil counts continued to increase, the patient was given suplatast, an anti-allergic agent. The symptoms and hematological values improved promptly. The patient recovered uneventfully, with no recurrence.

Topics: Anti-Allergic Agents; Anti-Bacterial Agents; Arylsulfonates; Biopsy; Diagnosis, Differential; Endoscopy, Gastrointestinal; Eosinophilia; Gastroenteritis; Humans; Immunoglobulin E; Male; Middle Aged; Minocycline; Sulfonium Compounds

Topics: Adult; Anti-Infective Agents; Drug-Related Side Effects and Adverse Reactions; Eosinophilia; Female; Hepatitis; Herpesvirus 6, Human; Humans; Male; Minocycline; Myocarditis; Roseolovirus Infections; Sulfasalazine

Minocycline-induced drug rash with eosinophilia and systemic symptoms (DRESS) may have a prolonged course, especially in African and African-American patients.. To determine if a prolonged course of minocycline-induced DRESS was associated with an accumulation of the culprit drug.. We determined plasma and skin levels of minocycline in patients with minocycline-induced DRESS. We investigated the genetic polymorphisms of enzymes potentially involved in the detoxification of the drug, glutathione S-transferases and UDP-glucuronosyltransferases.. We demonstrated the persistence of minocycline in the plasma and/or in the skin of 7 out of 9 patients with skin phototypes V-VI. As pigmented skin contains more melanin, this could promote the formation of a melanin-minocycline complex, which could explain the severe and prolonged DRESS which may occur in this subgroup of patients.

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Bacterial Agents; Black People; Chromatography, High Pressure Liquid; Drug Hypersensitivity; Eosinophilia; Female; Genetic Predisposition to Disease; Genotype; Glutathione Transferase; Humans; Male; Melanins; Middle Aged; Minocycline; Polymerase Chain Reaction; Polymorphism, Genetic; Sequence Deletion; Skin; Skin Pigmentation; Syndrome

Lung involvement is rarely observed in the DRESS syndrome (Drug rash with eosinophilia and systemic symptoms). We report here a severe minocycline induced hypersensitivity syndrome with initial respiratory distress.. A 19 year old man was admitted to the intensive care unit for acute respiratory distress with fever (400C), lymph node enlargement, hepatomegaly, splenomegaly and eosinophilia (1640/mm3). Bilateral alveolar opacities were observed on the chest x-ray. Sedation and mechanical ventilation rapidly became necessary because of severe hypoxaemia (47 mm Hg) and the sudden onset of severe aggressive behaviour. The diagnosis of DRESS was immediately suspected as the patient had been treated for acne with minocycline for 28 days, and IV corticosteroids (2 mmg/kg/day) were initiated. Skin lesions were delayed and appeared 3 days later. The outcome was uncertain for the following 6 weeks with serious disturbance of hepatic and renal function. Serology for human herpes virus (HHV6) was initially negative but became positive. One year later, after progressive withdrawal of corticosteroid therapy, the patient had made a complete recovery with no sequelae.. The DRESS syndrome can cause considerable morbidity with multiple, severe visceral functional disturbances. Respiratory physicians should be aware of this syndrome as lung involvement can be serious and may precede cutaneous symptoms.

Topics: Adult; Anti-Bacterial Agents; Drug Eruptions; Eosinophilia; Hepatomegaly; Humans; Hypoxia; Lymphatic Diseases; Male; Minocycline; Respiratory Distress Syndrome; Splenomegaly; Syndrome

Eosinophilic meningitis has been defined as meningitis in which a total cerebrospinal fluid (CSF) sample is found to have more than 10 eosinophils per millimeter or is composed of greater than 10% eosinophils. The differential diagnosis is broad and the clinical presentation, lacking an internalized CSF diversion system, is often nonspecific. With respect to patients with shunt systems, a positive correlation exists between CSF eosinophilia and eventual shunt failure requiring revision. In this paper the authors present the highest reported level of CSF eosinophilia in conjunction with a rifampin and minocycline-impregnated ventriculostomy catheter recently approved by the Food and Drug Administration.

Topics: Adolescent; Anti-Bacterial Agents; Antibiotics, Antitubercular; Catheterization; Diagnosis, Differential; Eosinophilia; Humans; Male; Meningitis; Minocycline; Rifampin; Ventriculostomy

Wells syndrome, also known as eosinophilic cellulitis, is an uncommon condition whose etiology often remains a mystery. Patients present with recurrent cutaneous swellings that are often cellulitic in appearance. Histopathologic evaluation of the skin lesions reveals a dense dermal eosinophilic infiltrate, marked edema, and characteristic "flame figures". Notably, the picture is devoid of vasculitis. Therapy with low-dose systemic steroids has proven variably successful. Clinical evidence lending support for the efficacy of other medications has been, for the most part, anecdotal. We present a case of Wells syndrome, review the literature, and discuss therapeutic options.

Topics: Administration, Cutaneous; Administration, Oral; Adult; Anti-Bacterial Agents; Anti-Inflammatory Agents; Cellulitis; Clobetasol; Diagnosis, Differential; Drug Therapy, Combination; Eosinophilia; Female; Humans; Minocycline; Niacinamide; Syndrome

Topics: Acne Vulgaris; Adrenal Cortex Hormones; Adult; Diagnosis, Differential; Eosinophilia; Female; Humans; Hypersensitivity; Minocycline; Myocardium; Shock, Cardiogenic

Topics: Adult; Cameroon; Drug Eruptions; Eosinophilia; Female; Humans; Minocycline; Syndrome

Topics: Adult; Anti-Bacterial Agents; Drug Hypersensitivity; Eosinophilia; Herpesvirus 6, Human; Humans; Male; Minocycline; Roseolovirus Infections

Topics: Anti-Bacterial Agents; Authorship; Electrocardiography; Eosinophilia; Humans; Minocycline; Pericarditis

This report describes a 15-year-old white boy who presented with fever, back pain, a disseminated exanthematous rash, renal failure, and hepatopathy 3 weeks after the initiation of oral minocycline therapy for facial acne. Marked peripheral and urine eosinophilia were noted. A bone marrow aspiration showed more than 50% eosinophils without any evidence of malignancy, and a simultaneous kidney biopsy showed acute interstitial nephritis (AIN). The patient's symptoms and laboratory findings improved after high-dose steroid therapy was initiated, worsened when it was withheld, and improved again after it was reinitiated in view of the biopsy findings. The patient recovered completely, and steroids were tapered to discontinuation over 3 months. Over a year later, the patient's peripheral blood mononuclear cells (PBMCs) were cultured for 2 weeks in the presence or absence of minocycline ex vivo, and minocycline was found to induce the emergence of CD4(+) cells after 1 week in culture. In conclusion, this article shows for the first time several new aspects of minocycline-induced morbidity: renal and hepatic failure can occur together, and AIN and elevated blood eosinophil counts can be accompanied by marked bone marrow eosinophilia, suggesting a systemic allergic response as the underlying pathomechanism. Furthermore, the initial phase of such a response appears to involve CD4(+) T cells detectable ex vivo. Lastly, high-dose treatment with corticosteroids appears to be beneficial in this setting.

Topics: Acne Vulgaris; Adolescent; CD4 Lymphocyte Count; Eosinophilia; Humans; Liver Failure, Acute; Male; Minocycline; Nephritis

Pericarditis, usually viral in origin, is an infrequent cause of chest pain. Pericarditis due to drug allergy is even less frequent and is thus rarely considered in the differential diagnosis. A case is reported of a woman who presented with severe chest pain, caused by minocycline induced pericarditis. Such allergy may be more common than reported. It is suggested that drug induced pericarditis should be included in the differential diagnosis of acute chest pain.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Chest Pain; Electrocardiography; Eosinophilia; Female; Humans; Minocycline; Pericarditis

Pneumonitis with eosinophilia is one of the less common and severe adverse effects of minocycline. The disease evolves in days or weeks from the beginning of treatment, and is usually characterized by dyspnea, fever and bilateral infiltrates in the chest X-ray. With cessation of the antibiotic, and sometimes adding cortico-steroids, clinical and roentgenological resolution follow. We present a case given minocycline for folliculitis and 3 weeks later fever, cough and shortness of breath developed. The clinical and roentgenological course was consistent with minocycline pneumonitis accompanied by eosinophilia.

Topics: Adult; Anti-Bacterial Agents; Eosinophilia; Folliculitis; Humans; Male; Minocycline; Pneumonia

Topics: Adverse Drug Reaction Reporting Systems; Anti-Bacterial Agents; Canada; Chemical and Drug Induced Liver Injury; Drug Eruptions; Eosinophilia; Fever; Humans; Lymphatic Diseases; Lymphocytosis; Minocycline

A 17-year-old female patient who had been taking oral minocycline (50 mg twice daily) for 3 weeks for acne developed an eruption that progressed to an exfoliative dermatitis. This illness was also characterized by fever, lymphadenopathy, pharyngitis, a leukemoid reaction, lymphocytosis, eosinophilia, hepatitis, and noncardiogenic pulmonary edema. Dramatic improvement followed institution of corticosteroid therapy. Studies for infectious and collagen vascular diseases were negative. This severe illness was likely caused by minocycline, and we speculate that minocycline may have acted as a superantigen, causing lymphocyte over-activation and massive cytokine release.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Chemical and Drug Induced Liver Injury; Drug Eruptions; Eosinophilia; Female; Fever; Hematologic Diseases; Humans; Lymphocytosis; Minocycline

Topics: Acne Vulgaris; Anti-Bacterial Agents; Black People; Chemical and Drug Induced Liver Injury; Dermatitis, Exfoliative; Drug Eruptions; Eosinophilia; Humans; Minocycline; Retrospective Studies; Risk; Risk Assessment

We identified eight patients (six women and two men) who had pulmonary infiltrates during treatment with minocycline hydrochloride between 1989 and 1992 in French referral centers for drug-induced pulmonary diseases. Clinical files, chest roentgenograms, computed tomographic scans, pulmonary function, and bronchoalveolar lavage data were reviewed. Minocycline treatment was given for acne (n = 4), genital infection (n = 3), and Lyme disease (n = 1). The duration of treatment averaged 13 +/- 5 days (mean +/- SE); the total dose, 2060 +/- 540 mg. Patients presented with dyspnea (n = 8), fever (n = 7), dry cough (n = 5), hemoptysis (n = 1), chest pain (n = 2), fatigue (n = 3), and rash (n = 3). Chest roentgenograms showed bilateral infiltrates in all cases. Pulmonary function was measured in five patients; four had airflow obstruction and two had mild restriction. Blood gas tests demonstrated hypoxemia in seven patients (58 +/- 3 mmHg). Seven patients had blood eosinophilia (1.76 +/- 0.2 x 10(9)/L). Bronchoalveolar lavage (performed in seven patients) showed an increased proportion of eosinophils (0.30 +/- 0.07). The Cd4+/CD8+ ratio was determined in four cases and was low in three. Transbronchial lung biopsy, performed in two patients, showed interstitial pneumonitis in both patients, with marked infiltration by eosinophils in one patient. The outcome was favorable in all patients. Because of severe symptoms, steroid therapy was required in three patients. Rechallenge was not attempted. We conclude that minocycline can induce the syndrome of pulmonary infiltrates and eosinophilia, that presenting symptoms may be severe and may culminate in transient respiratory failure, and that the disease has a favorable prognosis.

Topics: Adolescent; Adult; Eosinophilia; Female; Humans; Lung Diseases, Interstitial; Male; Middle Aged; Minocycline; Prognosis

Minocycline is a tetracycline agent frequently used for acne therapy. It has a few rare but severe side effects that are not widely known but should be recognized early as drug related. These include acute hepatitis and liver failure; a Löffler-like syndrome with pulmonary infiltrates, wheezing, fever, and eosinophilia; skin eruptions, eosinophilic cellulitis, and pustular folliculitis with eosinophilia; and a lupuslike syndrome. Side effects that are better known and recognized include photosensitization, skin exanthema with pruritus, and pseudotumor cerebri.

Topics: Acne Vulgaris; Adult; Drug Eruptions; Drug Hypersensitivity; Eosinophilia; Female; Fever; Humans; Liver; Lymphatic Diseases; Minocycline; Neutropenia

Acute pulmonary eosinophilia was observed in the patient after taking minocycline. The clinical picture recurred when the drug was re-introduced. However, this is a rare complication after taking a derivative of tetracycline. An eosinophilia was seen in the peripheral blood and also in the bronchoalveolar lavage. Cessation of the drug therapy without the addition of corticosteroids allowed a cure.

Topics: Acne Vulgaris; Adult; Bronchoalveolar Lavage Fluid; Drug Hypersensitivity; Eosinophilia; Humans; Male; Minocycline; Pulmonary Eosinophilia

All three patients complained of cough, fever and dyspnea. Their chest X-ray films revealed interstitial changes such as Kerley B lines. The results of lymphocyte stimulation tests were all negative for Minocycline (MINO), whereas the provocation tests were all positive in three cases. The onsets of symptoms appeared 7, 12 and 9 hours after administration of MINO respectively, which suggested type III allergy in terms of the latency period. In cases No. 1 and No. 3, lung tissue specimens obtained by transbronchial biopsy showed findings of mild acute eosinophilic pneumonia. The bronchoalveolar lavage fluid of case No. 3 showed eosinophilia. On diagnosing MINO-induced pneumonitis, the lymphocyte stimulation test is not always beneficial, whereas the provocation test is supposed to be a safe and sure method.

Topics: Adult; Aged; Bronchi; Bronchial Provocation Tests; Bronchoalveolar Lavage Fluid; Eosinophilia; Humans; Lymphocyte Activation; Male; Minocycline; Pneumonia

This report describes a patient with a drug reaction and histologic changes of both eosinophilic cellulitis and eosinophilic pustular folliculitis. We propose that some cases of eosinophilic pustular folliculitis, like eosinophilic cellulitis, may occur as a result of a hypersensitivity phenomenon.

Topics: Cellulitis; Drug Eruptions; Eosinophilia; Folliculitis; Humans; Male; Middle Aged; Minocycline