minocycline and Hepatitis--Autoimmune

Drug-induced liver injury (DILI) with features of autoimmunity (AI) represents an important category of hepatotoxicity due to medication exposure. Drugs repeatedly associated with AI-DILI include diclofenac, α-methyl DOPA, hydralazine, nitrofurantoin, minocycline, and more recently statins and anti-TNF-α agents. Usually, symptoms of acute liver injury occur within a few months after initiation of a culprit medication, but a longer latency period is possible. Like idiopathic autoimmune hepatitis, circulating autoantibodies and a hypergammaglobulinemia are frequently present in sera from patients with AI-DILI. If performed, a liver biopsy should demonstrate interface hepatitis with a prominent plasma cell infiltrate. The severity of AI-DILI is variable, but a complete resolution after withdrawal of the offending medication is the expectation. A response to corticosteroid therapy supports the diagnosis, whereas a lack of recurrence of symptoms or signs following corticosteroid cessation distinguishes AI-DILI from idiopathic autoimmune hepatitis.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Antihypertensive Agents; Autoantibodies; Autoimmunity; Chemical and Drug Induced Liver Injury; Cytokines; Diagnosis, Differential; Drug Hypersensitivity; Female; Hepatitis, Autoimmune; HLA Antigens; Humans; Hydralazine; Hypergammaglobulinemia; Liver; Liver Function Tests; Male; Methyldopa; Minocycline; Nitrofurantoin; Time Factors; Young Adult

The clinical phenotype of classical autoimmune hepatitis can be mimicked by idiosyncratic drug-induced liver injury, and differentiation can be difficult. The goals of this review are to enumerate the major agents of drug-induced autoimmune-like hepatitis, describe the clinical findings and risk factors associated with it, detail the clinical tools by which to assess causality, discuss putative pathogenic mechanisms, and describe treatment and outcome. The frequency of drug-induced autoimmune-like hepatitis among patients with classical features of autoimmune hepatitis is 9%. Minocycline and nitrofurantoin are implicated in 90% of cases. Female predominance, acute onset, and absence of cirrhosis at presentation are important clinical manifestations. Genetic factors affecting phase I and phase II transformations of the drug, polymorphisms that protect against cellular oxidative stress, and human leukocyte antigens that modulate the immune response may be important pathogenic components. Clinical judgment is the mainstay of diagnosis as structured diagnostic methods for drug-induced liver injury are imperfect. The covalent binding of a reactive drug metabolite to a hepatocyte surface protein (commonly a phase I or phase II enzyme), formation of a neoantigen, activation of CD8 T lymphocytes with nonselective antigen receptors, and deficient immune regulatory mechanisms are the main bases for a transient loss of self-tolerance. Discontinuation of the offending drug is the essential treatment. Spontaneous improvement usually ensues within 1 month. Corticosteroid therapy is warranted for symptomatic severe disease, and it is almost invariably effective. Relapse after corticosteroid withdrawal probably does not occur, and its absence distinguishes drug-induced disease from classical autoimmune hepatitis.

Topics: Adrenal Cortex Hormones; Anti-Infective Agents; Autoantibodies; Chemical and Drug Induced Liver Injury; Female; Hepatitis, Autoimmune; HLA Antigens; Humans; Immune Tolerance; Male; Minocycline; Nitrofurantoin; Oxidative Stress; Polymorphism, Genetic; Risk Factors; Sex Factors; Treatment Outcome

To increase awareness of minocycline-induced autoimmune syndromes.. Review of relevant publications from the American and European literature.. Four minocycline-induced syndromes have been described in 82 patients: serum sickness, drug-induced lupus, autoimmune hepatitis, and vasculitis. Aside from sporadic cases of serum sickness, all other syndromes occurred in patients treated for acne. Drug-induced lupus and hepatitis were by far the most common events (66 cases). Except for serum sickness, which presented shortly (mean, 16 days) after minocycline, the autoimmune syndromes manifested after protracted use (mean, 25.3 months). As expected, the patients with acne were young (mean, 19.7 years). The most frequent symptoms were arthralgia, followed by arthritis, fever, and rash (73, 45, 38, and 29 patients, respectively). Serologically, antinuclear antibodies were the most common finding (63 positive of 68 tests); perinuclear anti-neutrophilic cytoplasmic antibodies (pANCA), when assayed, were similarly frequent (20 of 24 tests). Surprisingly, anti-histone antibodies were uncommon, even among patients with drug-induced lupus (4 of 31 tests). The clinical and serological features of the separate syndromes may overlap. The diagnostic value of pANCA, as well as its possible role in minocycline-induced autoimmunity, are discussed.. Minocycline has the potential to evoke a variety of clinical and serological autoimmune expressions. The number of published reports may underestimate the frequency of this condition, which should be suspected and investigated in young patients with autoimmune manifestations.

Topics: Anti-Bacterial Agents; Antibodies, Antineutrophil Cytoplasmic; Autoimmune Diseases; Hepatitis, Autoimmune; Humans; Iatrogenic Disease; Lupus Erythematosus, Systemic; Minocycline; Serum Sickness; Vasculitis

Minocycline is an antibiotic commonly used in the treatment of adolescent acne.. To describe the clinical, laboratory, and histological features in 3 cases of minocycline-related autoimmune hepatitis and to review the literature of similar cases in the adolescent population.. Case series.. Patients were cared for in the Division of Gastroenterology, Children's Hospital, Boston, Mass.. Three adolescents (age, 15-16 years), while being treated with therapeutic doses of minocycline for periods of 12 to 20 months, met the 1993 International Autoimmune Hepatitis Group criteria for autoimmune hepatitis. All had a positive antinuclear antibody titer. Other features included hypergammaglobulinemia and a positive anti-smooth muscle antibody titer. Two patients underwent liver biopsy that revealed severe chronic lymphoplasmacytic inflammation, necrosis, and fibrosis. All other causes of liver disease were excluded. One patient had resolution of symptoms with withdrawal of the drug, while 2 required immunosuppression therapy. A review of the literature yielded only 18 similar cases, none in the pediatric literature, the majority of which contained incomplete pertinent data.. Minocycline is related to the development of autoimmune hepatitis in some adolescents. Pediatricians who use this drug for treatment of acne should be aware of this serious potential relation and stop the drug immediately when suspicion is raised.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Chemical and Drug Induced Liver Injury, Chronic; Female; Hepatitis, Autoimmune; Humans; Male; Minocycline

This study was performed to raise awareness among rheumatologists about two autoimmune disorders associated with long-term minocycline therapy that can coexist in the same patient. We provide an update on the occurrence of these disorders, their main characteristics, and the current knowledge of potential pathogenic mechanisms.. We searched the medical literature in English indexed in MEDLINE from 1966 through April 1998 for the term minocycline combined with each of the following: autoimmune hepatitis (AIH), chronic hepatitis, lupus, systemic lupus erythematosus (SLE), anti-myeloperoxidase (anti-MPO), arthritis, vasculitis, and toxicity. We also reviewed relevant references cited in the articles our search uncovered.. We identified over 60 minocycline-induced cases of SLE and 24 cases of minocycline-induced AIH. Both autoimmune disorders coexisted in the same patient in 12 cases reported in the literature and in one case seen at our clinic. These 13 patients were characterized by symmetrical polyarthralgias/polyarthritis, elevated liver enzymes, and positive antinuclear antibodies (ANA); they also were generally anti-histone-negative, and only two patients had perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA). After withdrawal of minocycline, their symptoms resolved, and abnormal laboratory results normalized or markedly improved.. Although data on the actual prevalence of autoimmune disorders induced by minocycline are not available, numerous case reports or small series deal with such disorders. Probable pathogenic mechanisms for each of these conditions are discussed.

Topics: Adult; Anti-Bacterial Agents; Antibodies, Antinuclear; Female; Hepatitis, Autoimmune; Humans; Lupus Erythematosus, Systemic; Minocycline; Peroxidase

Minocycline is the most commonly used systemic antibiotic in the long-term treatment (weeks to months) of severe acne vulgaris. Currently much attention is being paid in the Dutch and international literature to the safety of minocycline, after several reports on serious adverse events. The clinical efficacy of minocycline in the treatment of acne vulgaris is better than that of tetracycline and equal to that of doxycycline. The serious adverse events of minocycline therapy described consist of hyperpigmentation of various tissues, autoimmune disorders (systemic lupus erythematosus, autoimmune hepatitis) and serious hypersensitivity reactions (hypersensitivity syndrome reaction, pneumonitis and eosinophilia, and serum sickness-like syndrome). In relation to the number of prescriptions, the number of serious adverse events of minocycline described is small. However, it is very important that prescribing doctors should be aware of the possibility of these adverse events occurring during long-term minocycline therapy and able to recognize the characteristic symptoms at an early stage.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Drug Hypersensitivity; Hepatitis, Autoimmune; Humans; Lupus Erythematosus, Systemic; Minocycline; Pigmentation Disorders; Pulmonary Eosinophilia; Serum Sickness; Syndrome

Nitrofurantoin, minocycline, methyldopa and infliximab, have been found to induce autoimmune-like hepatitis (DI-AILH). Evidence for other drugs and herbal and dietary supplements (HDS) is unclear. The aims of the study were to establish criteria to define and review the published evidence of suspected DI-AILH. Search was undertaken in Pubmed using search terms "drug-induced liver injury," "autoimmune hepatitis," and "drug-induced autoimmune hepatitis." DI-AILH was defined as (1) drug as a potential trigger of liver injury with autoimmune features and histological findings compatible with AIH; (2) no or incomplete recovery or worsening of liver tests after discontinuation of the drug; (3) corticosteroids requirement or spontaneous recovery; (4) follow-up without immunosuppression (IS) and no relapse of AIH at least 6 months after discontinuation of IS; and (5) drugs potentially inducing AILH with a chronic course. Cases fulfilling the first four criteria were considered probable DI-AILH with three possible DI-AILH. A total of 186 case reports were identified for conventional drugs (n = 148; females 79%; latency 2.6 months) and HDS (n = 38; females 50%). The most commonly reported agents of DI-AILH were interferons (n = 37), statins (n = 24), methylprednisolone (MPS) (n = 16), adalimumab (n = 10), imatinib (n = 8), and diclofenac (n = 7). Tinospora cordifolia and Khat were the only HDS with probable DI-AILH cases. No relapses of AIH were observed when IS was stopped after interferons, imatinib, diclofenac, and methylprednisolone. Conclusion: Beyond well-recognized nitrofurantoin, methyldopa, hydralazine, minocycline, and infliximab as causes of DI-AILH, interferons, imatinib, adalimumab, and MPS were the best-documented agents leading to probable DI-AILH. Khat and Tinospora cordifolia were the only HDS found to be able to induce DI-AILH. Long-term immunosuppression appears to be rarely required in patients with DI-AILH due to these drugs.

Topics: Adalimumab; Chemical and Drug Induced Liver Injury; Diclofenac; Female; Hepatitis A; Hepatitis, Autoimmune; Humans; Imatinib Mesylate; Infliximab; Interferons; Methyldopa; Methylprednisolone; Minocycline; Nitrofurantoin

Over the past two years, the entire medical community has taken up the fight against the new coronavirus infection. At the initial encounter with COVID-19, it seemed that this virus mainly affects the respiratory system. Still, with long-term observation, it turned out that the consequences of this disease can be much more severe and associated with lung damage and thromboembolic complications, and be a trigger for autoimmune diseases. According to the literature, after suffering COVID-19, some patients debuted systemic lupus erythematosus, hemolytic anemia, thrombocytopenia, developed GuillainBarr syndrome, vasculitis, and multiple sclerosis, and a case of autoimmune hepatitis (AIH) was described in foreign literature. AIH is a fairly rare disease, the prevalence of which in Europe is 1618 cases per 100 thousand inhabitants, affecting mainly women. It is known that chemicals and drugs (minocycline, diclofenac, methyldopa, infliximab, etanercept), viruses (HAV, HEV, EBV, HCV, CMV), environmental factors can serve as triggers of the autoimmune process in the liver. This article presents two clinical cases of AIH that developed after suffering a new coronavirus infection, which we consider as the initial provoking factor of autoimmune inflammation. Given the rarity of AIH, the description of new triggers is of clinical interest. It may be useful for doctors of different specialties since they faced drug-induced liver damage against the background of antiviral and immunobiological therapy. In the domestic literature, there have not yet been any publications devoted to the debut of AIH in adults after coronavirus infection.. В течение последних 2 лет все медицинское сообщество встало на борьбу с новой коронавирусной инфекцией. При первичном столкновении с COVID-19 казалось, что этот вирус поражает преимущественно респираторную систему, но при длительном наблюдении выяснилось, что последствия этой болезни могут быть куда более тяжелыми, сопряженными с поражением легких и тромбоэмболическими осложнениями, а также являться пусковым механизмом для аутоиммунных заболеваний. Согласно литературным данным после перенесенного COVID-19 у некоторых пациентов дебютировали системная красная волчанка, гемолитическая анемия, тромбоцитопения, развивались синдром ГийенаБарре, васкулиты и рассеянный склероз, также в зарубежной литературе описан случай аутоиммунного гепатита (АИГ), который является достаточно редким заболеванием, распространенность которого в Европе составляет 1618 случаев на 100 тыс. жителей, поражает преимущественно женщин. Известно, что в качестве триггеров аутоиммунного процесса в печени могут послужить химические вещества и лекарства (миноциклин, диклофенак, метилдопа, инфликсимаб, этанерцепт), вирусы (HAV, HEV, EBV, HCV, CMV), факторы внешней среды. В данной статье представлены два клинических примера АИГ, развившегося после перенесенной новой коронавирусной инфекции, которая рассматривается нами в качестве первоначального провоцирующего фактора аутоиммунного воспаления. Учитывая редкость АИГ, описание новых триггеров вызывает клинический интерес, может оказаться полезным для врачей разных специальностей, так как ранее в основном сталкивались с лекарственно-индуцированным поражением печени на фоне противовирусной и иммунобиологической терапии. В отечественной литературе пока не встречалось публикаций, посвященных дебюту АИГ у взрослых после коронавирусной инфекции.

Topics: Adult; Antiviral Agents; COVID-19; Diclofenac; Etanercept; Female; Hepatitis, Autoimmune; Humans; Infliximab; Male; Methyldopa; Minocycline

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

Drug-induced autoimmune hepatitis is an acute and potentially severe side effect, particularly often reported after the long-term use of minocycline. The condition's characteristic biochemical findings are highly elevated transaminase levels, only mildly increased markers of cholestasis and bilirubin levels, an elevated IgG concentration and a high antinuclear antibody (ANA) titre.. A 14-year-old girl developed autoimmune hepatitis due to the long-term use of minocycline for acne vulgaris. She presented with icterus and very high transaminase levels. The patient made a full recovery after the medication was discontinued.. This type of autoimmune hepatitis can be differentiated from 'classic' autoimmune hepatitis by the patient's quick recovery after stopping the inducing drug and no relapse of the condition after the discontinuation of glucocorticoid therapy.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Antibodies, Antinuclear; Chemical and Drug Induced Liver Injury; Female; Hepatitis, Autoimmune; Humans; Immunoglobulin G; Minocycline

Topics: Anti-Infective Agents; Female; Hepatitis, Autoimmune; Humans; Male; Minocycline; Nitrofurantoin

Topics: Anti-Infective Agents; Female; Hepatitis, Autoimmune; Humans; Male; Minocycline; Nitrofurantoin

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Female; Hepatitis, Autoimmune; Humans; Male; Minocycline; Nitrofurantoin

Drug-induced autoimmune hepatitis (DIAIH) has been reported to be caused by several drugs. There is a lack of data comparing these patients with other patients with autoimmune hepatitis (AIH). A search was performed using the Mayo Clinic diagnostic medical index for AIH patients and DIAIH patients identified over 10 years. Individuals with overlap syndromes and decompensated liver disease were excluded. Overall, 261 patients (204 females, median age 52) were identified, and 24 (9.2%) were DIAIH cases with a median age of 53 (interquartile range, 24-61). Two drugs, nitrofurantoin (n = 11) and minocycline (n = 11), were the main causes. A similar proportion of DIAIH patients had positive antinuclear antibodies (83% versus 70%) and smooth muscle antibodies (50% versus 45%) as compared with AIH patients. Histological grade and stage were similar in patients with DIAIH versus AIH; however, none of the DIAIH patients had cirrhosis at baseline; this was present in 20% of matched AIH cases. Liver imaging was normal in all minocycline cases. Eight of 11 (73%) nitrofurantoin patients had abnormalities on hepatic imaging (mainly liver atrophy), a finding seen in only 8 of 33 (24%) of a random sample of the rest of the AIH group (P = 0.0089). Corticosteroid responsiveness was similar in DIAIH and the AIH patients. Discontinuation of immunosuppression was tried and successful in 14 DIAIH cases, with no relapses (0%), whereas 65% of the AIH patients had a relapse after discontinuation of immunosuppression (P < 0.0001).. A significant proportion of patients with AIH have drug-induced AIH, mainly because of nitrofurantoin and minocycline. These two groups have similar clinical and histological patterns. However, DIAIH patients do not seem to require long-term immunosuppressive therapy.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Female; Hepatitis, Autoimmune; Humans; Male; Middle Aged; Minocycline; Nitrofurantoin; Prognosis; United States; Young Adult

Topics: Clinical Enzyme Tests; Hepatitis, Autoimmune; Humans; Immunosuppressive Agents; Liver; Minocycline; Nitrofurantoin; Tumor Necrosis Factor-alpha

Over the years, a variety of abnormal immune reactions to minocycline have been reported including arthritis, systemic lupus erythematosus, and hepatitis. The current report describes the detailed clinical and pathologic features of 3 patients who presented with chronic/autoimmune hepatitis alone while on minocycline at our hospital over a 2-year period. Minocycline use in these patients was temporally related to onset of severe hepatitis. Adolescents with such a reaction to minocycline have been included in previous reports but have not been well described as a distinct entity. We have compared our cases with similar cases previously reported with a review of the literature and a discussion of the implications for prescribing physicians.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Chemical and Drug Induced Liver Injury, Chronic; Female; Hepatitis, Autoimmune; Humans; Male; Minocycline; Severity of Illness Index

Of the tetracyclines, minocycline is unique in causing a significant incidence of a lupus-like syndrome and autoimmune hepatitis. It is also unique among the tetracyclines in having a para-N,N-dimethylaminophenol ring. Many drugs that cause autoimmune reactions are oxidized to reactive metabolites by the myeloperoxidase (MPO) system of macrophages. In this study, we showed that minocycline is oxidized to reactive intermediates by MPO/H(2)O(2)/Cl(-), HOCl, horseradish peroxidase/H(2)O(2), or hepatic microsomes. When trapped with N-acetylcysteine (NAC), two adducts with protonated molecular ions at m/z 619 were isolated and analyzed by NMR. One represents attack of the aromatic D ring by NAC meta to the N,N-dimethylamino group, which implies that the reactive intermediate was a quinone iminium ion. The NMR of the other adduct, which was not observed when minocycline was oxidized by hepatic microsomes, indicates that the NAC is attached at the junction of the B and C rings. In the oxidation by HOCl, we found an intermediate with a protonated molecular ion of m/z 510 that represents the addition of HOCl to minocycline. The HOCl presumably adds across the double bond of the B ring, and reaction of this intermediate with NAC led to the second NAC adduct. We were surprised to find that the same NAC adduct was not observed after oxidation of tetracycline with HOCl, even though this part of the tetracycline structure is the same as for minocycline. We propose that one or more of these reactive metabolites are responsible for the idiosyncratic drug reactions that are specific to this tetracycline.

Topics: Acetylcysteine; Animals; Anti-Bacterial Agents; Biotransformation; Chromatography, High Pressure Liquid; Free Radical Scavengers; Free Radicals; Hepatitis, Autoimmune; Horseradish Peroxidase; In Vitro Techniques; Lupus Erythematosus, Systemic; Magnetic Resonance Spectroscopy; Male; Microsomes, Liver; Minocycline; Oxidation-Reduction; Peroxidase; Rats; Rats, Inbred BN; Tandem Mass Spectrometry

Topics: Adolescent; Female; Hepatitis, Autoimmune; Humans; Liver Function Tests; Minocycline

Minocycline is an effective antibiotic widely used in the treatment of acne vulgaris. We report a previously well 20-year-old woman who developed liver dysfunction with jaundice and malaise following a 1 year course of minocycline for acne vulgaris. Serum antinuclear antibody was strongly positive (1 : 2560) and liver transaminases were grossly deranged. All other causes of liver disease were excluded. Both the clinical symptoms and laboratory abnormalities resolved spontaneously on stopping the drug. We review the three different types of hepatotoxicity associated with minocycline and draw evidence to support the diagnosis of minocycline-induced autoimmune hepatitis. This case supports the call to monitor patients on minocycline therapy for autoimmune disease of the liver and highlights the need for a multicentre prospective trial of the risks and benefits of long-term minocycline therapy.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Chemical and Drug Induced Liver Injury; Female; Hepatitis, Autoimmune; Humans; Minocycline

Topics: Adolescent; Anti-Bacterial Agents; Chemical and Drug Induced Liver Injury; Hepatitis, Autoimmune; Humans; Minocycline

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Female; Hepatitis, Autoimmune; Humans; Immunoglobulins, Intravenous; Minocycline; Purpura, Thrombocytopenic, Idiopathic

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Antihypertensive Agents; Hepatitis, Autoimmune; Humans; Hypertension; Immunosuppressive Agents; Liver; Liver Cirrhosis; Lupus Vulgaris; Male; Minocycline

A 25-year-old woman with no history of liver disease developed liver dysfunction associated with severe jaundice and general malaise following a prolonged therapy with minocycline for acne vulgaris. Serum anti-nuclear antibody was detected and immunoglobulin G level was elevated. Symptoms resolved and liver function normalized following minocycline discontinuation and corticosteroid administration. Our diagnosis was drug-induced hepatitis with autoimmune features, as liver histology revealed acute hepatitis. Drug-induced hepatitis should be considered when liver dysfunction or systemic symptoms develops during long-term minocycline therapy.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Antibodies, Antinuclear; Chemical and Drug Induced Liver Injury; Female; Hepatitis, Autoimmune; Humans; Immunoglobulin G; Minocycline

Topics: Adolescent; Anti-Bacterial Agents; Autoimmune Diseases; Female; Hepatitis, Autoimmune; Humans; Lupus Erythematosus, Systemic; Minocycline; Risk Factors

Topics: Adolescent; Anti-Bacterial Agents; Female; Hepatitis, Autoimmune; Humans; Male; Minocycline

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Antibodies, Antinuclear; Female; Hepatitis, Autoimmune; Humans; Immunoglobulin G; Jaundice; Liver Failure; Liver Transplantation; Minocycline

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Female; Hepatitis, Autoimmune; Humans; Lupus Vulgaris; Minocycline

We describe the clinical and liver biopsy morphologic features for 4 patients with minocycline-induced autoimmune hepatitis (group 1). We compared the serum laboratory values and liver biopsy findings from group 1 with those from 10 patients with sporadic autoimmune hepatitis (group 2). All patients in group 1 had positive serum antinuclear antibody titers, but none had positive serum anti-smooth muscle antibody titers. The morphologic findings of group 1 biopsies were those of autoimmune hepatitis in all 4 patients. In addition, 1 of these biopsy specimens also had scattered single eosinophils, unlike autoimmune hepatitis. The mean histologic activity index scores for patients in groups 1 and 2, respectively, were 6.7 and 5.4. No patients in group 1 had marked bridging fibrosis or cirrhosis, compared with 4 of 10 patients in group 2. Minocycline-induced autoimmune hepatitis is usually identical to sporadic autoimmune hepatitis. The absence of eosinophils does not exclude the possibility of a minocycline cause. In the absence of clinical or morphologic differences, a recent ingestion of minocycline should be excluded before the diagnosis of sporadic autoimmune hepatitis is established. Whether the drug is unmasking latent autoimmune hepatitis is unclear.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Antibodies, Antinuclear; Biopsy; Blood Sedimentation; Chemical and Drug Induced Liver Injury; Female; Glucocorticoids; Hepatitis, Autoimmune; Humans; Liver; Liver Function Tests; Male; Middle Aged; Minocycline; Muscle, Smooth

Topics: Adult; Anti-Bacterial Agents; Female; Hepatitis, Autoimmune; Humans; Lupus Erythematosus, Systemic; Minocycline

Among several adverse effects following treatment with minocycline, certain cases of autoimmune hepatitis, associated with lupus erythematosus, have been described. The possibility of hepatic damage, although rare, is important to keep in mind because of its delicate diagnostic.. We report one case of autoimmune hepatitis following treatment with minocycline for acne, in a 25-year-old woman. This autoimmune hepatitis was associated with induced lupus syndrome. Usual causes of hepatitis were eliminated. Evolution was spontaneously favorable upon minocycline treatment interruption, with the disappearance of clinical symptoms and normalization of hepatic and immunologic biological values.. The possibility of hepatic damage and lupus syndrome, following treatment with minocycline, should be recalled and verified in cases of long-term prescription. This observation stresses the difficulties of anamnesis in internal medicine. For those who know how to listen cautiously and rigorously, anamnesis may prove more helpful than many complementary examinations.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Female; Hepatitis, Autoimmune; Humans; Lupus Vulgaris; Minocycline; Syndrome

Minocycline can cause various types of hepatotoxicity. We report an 18-year-old male who developed a delayed onset of minocycline-induced cholestatic hepatitis with autoimmune features and neutropenia. He responded to withdrawal of the drug and a short course of corticosteroids. If minocycline is to be administered, then periodic monitoring for hepatoxicity is recommended.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Chemical and Drug Induced Liver Injury; Hepatitis, Autoimmune; Humans; Male; Minocycline; Neutropenia

Topics: Anti-Bacterial Agents; Arthralgia; Hepatitis, Autoimmune; Humans; Minocycline; Pleurodynia, Epidemic