minocycline and Lupus-Erythematosus--Systemic

Drug-induced lupus erythematosus (DILE) is defined as an entity characterized by clinical manifestations and immunopathological serum findings similar to those of idiopathic lupus but which is temporally related to continuous drug exposure and resolves after discontinuation of the offending drug. Similar to idiopathic lupus, DILE can be divided into systemic lupus erythematosus (SLE), subacute cutaneous lupus erythematosus (SCLE) and chronic cutaneous lupus erythematosus (CCLE). Based on the literature review and retrospective analysis of our case series, we focused on the dermatological aspects of DILE. The cutaneous features of drug-induced SLE are protean, including particularly purpura, erythema nodosum and photosensitivity as well as the skin lesions characterizing both urticarial and necrotizing vasculitis. The typical laboratory profile of systemic DILE consists of positive antinuclear antibodies (ANA) and antihistone antibodies, the latter being regarded as the serum marker of this subset. The drugs most frequently implicated in the development of systemic DILE are hydralazine, procainamide, isoniazid and minocycline. Drug-induced SCLE usually presents with annular polycyclic or papulosquamous cutaneous manifestations as in the idiopathic form, but blisters or targetoid lesions mimicking erythema multiforme cannot rarely be associated. The clinical presentation is often generalized, with involvement of the lower legs that are usually spared in idiopathic SCLE. ANA and anti-Ro/SSA antibodies are usually present, whereas antihistone antibodies are uncommonly found. Drugs associated with SCLE include particularly calcium channel blockers, angiotensin-converting enzyme inhibitors, thiazide diuretics, terbinafine and the recently reported tumour necrosis factor (TNF)-alpha antagonists. Drug-induced CCLE is very rarely described in the literature and usually refers to fluorouracile agents or TNF-alpha antagonists. The picture is characterized by the occurrence of classic discoid lesions, but aspects of lupus tumidus can occasionally develop. ANA are demonstrated in around two-thirds of the cases. Management of DILE is based on the withdrawal of the offending drug. Topical and/or systemic corticosteroids and other immunosuppressive agents should be reserved for resistant cases.

Topics: Anti-Arrhythmia Agents; Anti-Bacterial Agents; Antihypertensive Agents; Antitubercular Agents; Autoantibodies; Drug-Related Side Effects and Adverse Reactions; Humans; Hydralazine; Isoniazid; Lupus Erythematosus, Cutaneous; Lupus Erythematosus, Discoid; Lupus Erythematosus, Systemic; Minocycline; Procainamide; Skin Diseases

From time to time there have been reports of autoimmune disease succumbing to tetracycline antibiotics, but many have assumed this was due to coincidence, or to some ill-defined 'anti-inflammatory property' of the tetracyclines. But now the inflammation of sarcoidosis has succumbed to antibiotics in two independent studies. This review examines the cell wall deficient (antibiotic resistant) bacteria which have been found in tissue from patients with sarcoidosis. It examines how such bacteria can infect the phagocytes of the immune system, and how they may therefore be responsible for not only sarcoid inflammation, but also for other autoimmune disease. Proof positive of a bacterial pathogenesis for Sarcoidosis includes not only the demonstrated ability of these studies to put the disease into remission, but also the severity of Jarisch-Herxheimer shock resulting from endotoxin release as the microbes are killed. Studies delineating the hormone responsible for phagocyte differentiation in the Th1 immune response, 1,25-dihydroxyvitamin D, are discussed, and its utility as a marker of Th1 immune inflammation is reviewed. Finally, data showing that the behavior of this hormone is also aberrant in rheumatoid arthritis, systemic lupus erythematosus, and Parkinson's, raise the possibility that these diseases may also have a CWD bacterial pathogenesis.

Topics: Animals; Anti-Bacterial Agents; Arthritis, Rheumatoid; Autoimmune Diseases; Bacteria; Doxycycline; Forecasting; Humans; Lupus Erythematosus, Systemic; Minocycline; Parkinson Disease; Phagocytes; Sarcoidosis; Secondary Prevention; Tetracyclines; Vitamin D

Minocycline has increasingly been associated with different adverse auto-immune reactions including drug-induced lupus.. To identify the scope of minocycline-induced lupus and to characterise its typical features.. Comprehensive Medline and Embase search of the English and non-English literature for case reports of minocycline-induced lupus.. We included 57 cases of minocycline-induced lupus (mean age +/- SD at onset: 21.6+/-8.6 years, median time of exposure: 19 months, range 3 days to 6 years). All patients showed the clinical features of polyarthralgia/polyarthritis often accompanied by liver abnormalities. Twelve patients had evidence of dermatological manifestations (i.e rash, livedo reticularis, oral ulceration, subcutaneous nodules, alopecia). The ANA test was positive in all patients.. Long-term exposure to minocycline may be associated with drug-induced lupus. Baseline and periodic liver function and ANA tests accompanied by appropriate clinical monitoring are suggested for patients receiving long-term minocycline therapy.

Topics: Adolescent; Adult; Age of Onset; Anti-Bacterial Agents; Antibodies, Antinuclear; Female; Humans; Lupus Erythematosus, Systemic; Male; Middle Aged; Minocycline

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 the most widely prescribed systemic antibiotic for the management of acne. In the past several years, increasing attention has been paid to the drug, both for its potential use as a disease-modifying antirheumatic agent and for its propensity to engender untoward autoimmune reactions, including serum sickness-like disease, drug-induced lupus, and autoimmune hepatitis. This paper reviews the evidence for minocycline as an anti-inflammatory and immunomodulatory agent, its utility in the treatment of rheumatoid arthritis, and the spectrum of adverse reactions that have been ascribed to the drug in the past 5 years.

Topics: Acne Vulgaris; Animals; Anti-Bacterial Agents; Arthritis; Arthritis, Rheumatoid; Autoimmune Diseases; Chemical and Drug Induced Liver Injury; Drug Hypersensitivity; Female; Humans; Lupus Erythematosus, Systemic; Male; Minocycline; Vasculitis

Topics: Anti-Bacterial Agents; Autoimmune Diseases; Humans; Lupus Erythematosus, Systemic; 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

To report a case of drug-induced lupus occurring 5 months after the initiation of minocycline therapy for acne.. Case report information was obtained from the physician, patient's family, and the medical record. MEDLINE and Index Medicus were searched to obtain relevant published literature from 1966 to 1996.. A 14-year-old white girl developed symptoms of myalgias, arthralgias, polyarthritis, and flushed face. The antinuclear antibody test was positive. Minocycline was discontinued and the patient's condition dramatically improved within 7 days.. Healthcare providers should recognize early common and unusual symptoms of minocycline-induced lupus in adolescents being treated for acne.

Topics: Adolescent; Anti-Bacterial Agents; Antibodies, Antinuclear; Female; Humans; Lupus Erythematosus, Systemic; Minocycline

Because minocycline can cause serious adverse events including hypersensitivity syndrome reaction (HSR), serum sicknesslike reaction (SSLR), and drug-induced lupus, a follow-up study based on a retrospective review of our Drug Safety Clinic and the Health Protection Branch databases and a literature review was conducted to determine if similar rare events are associated with tetracycline and doxycycline. Cases of isolated single organ dysfunction (SOD) attributable to the use of these antibiotics also were identified.. Nineteen cases of HSR due to minocycline, 2 due to tetracycline, and 1 due to doxycycline were identified. Eleven cases of SSLR due to minocycline, 3 due to tetracycline, and 2 due to doxycycline were identified. All 33 cases of drug-induced lupus were attributable to minocycline. Forty cases of SOD from minocycline, 37 cases from tetracycline, and 6 from doxycycline were detected. Hypersensitivity syndrome reaction, SSLR, and SOD occur on average within 4 weeks of therapy, whereas minocycline-induced lupus occurs on average 2 years after the initiation of therapy.. Early serious events occurring during the course of tetracycline antibiotic treatment include HSR, SSLR, and SOD. Drug-induced lupus, which occurs late in the course of therapy, is reported only with minocycline. We theorize that minocycline metabolism may account for the increased frequency of serious adverse events with this drug.

Topics: Adolescent; Adult; Adverse Drug Reaction Reporting Systems; Anti-Bacterial Agents; Arthralgia; Canada; Databases as Topic; Doxycycline; Drug Eruptions; Drug Hypersensitivity; Drug Prescriptions; Female; Fever; Follow-Up Studies; Humans; Liver; Lupus Erythematosus, Systemic; Male; Middle Aged; Minocycline; Retrospective Studies; Safety; Serum Sickness; Syndrome; Tetracycline; Time Factors

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

The association between guttate psoriasis and infection with group A Streptococcus (GAS) has been well established in the medical literature. However, responses to treatments aimed at GAS eradication such as systemic antibiotics or tonsillectomy are inconsistent. Further complicating treatment recommendations for a disease with a suspected microbial trigger, the standard therapy for severe psoriasis is with systemic immunosuppressant medications. This case report illustrates the role of GAS as a trigger for acute onset severe psoriasis in a child whose skin disease initially worsened with a trial of methotrexate. An immune evaluation confirmed a co-existing selective antibody deficiency. Subsequent treatment with intravenous immune globulin dramatically improved his underlying immune function and decreased GAS infections. This improvement in overall immune function and decrease in GAS infections cleared his skin disease. An interval change in formulation to subcutaneous immune globulin was not as effective.

Topics: Adolescent; Anti-Bacterial Agents; Humans; Lupus Erythematosus, Systemic; Male; Minocycline; Urticaria

An 18-year-old Japanese girl had received oral minocycline 200mg daily for treatment of acne vulgaris since 16 years old. She had a fever three months before admission, followed by joint pains in her knees, elbows and several proximal interphalangeal joints one month before admission. She was referred to our hospital because of a high serum level of anti-DNA antibody. She had already discontinued oral minocycline five weeks before admission, because she missed her medication refilled. On admission, the arthralgia and fever spontaneously resolved, and there were no laboratory evidence of hypocomplementemia and cytopenia. She had neither erythema nor internal organ involvements. Because her symptoms subsided spontaneously after the cessation of minocycline, she was considered to have drug-induced lupus. Both the arthralgia and fever did not relapse, and anti-ds DNA antibody returned to normal during a follow-up period without treatment. There are few reports of drug-induced lupus caused by minocycline in Japan. This case highlights the importance of considering minocycline-induced lupus.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Antibodies, Antinuclear; Biomarkers; Female; Humans; Lupus Erythematosus, Systemic; Minocycline; Time Factors

Topics: Acne Vulgaris; Anti-Bacterial Agents; Diagnosis, Differential; Humans; Lupus Erythematosus, Systemic; Lyme Disease; Male; Minocycline

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

Topics: Anti-Bacterial Agents; Antimalarials; Diagnosis, Differential; Humans; Hyperpigmentation; Lupus Erythematosus, Systemic; Minocycline; Mouth Diseases; Mouth Mucosa; Palate, Hard

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

An 18-year-old patient is described who presented with febrile neutropenia and hepatitis caused by minocycline therapy. This rare complication of minocycline-induced lupus syndrome is discussed here.

Topics: Acne Vulgaris; Adolescent; Antibodies, Antineutrophil Cytoplasmic; Autoantibodies; Humans; Lupus Erythematosus, Systemic; Male; Minocycline; Neutropenia

Minocycline (MN), one of the commonly prescribed therapies for acne, is known to be associated with autoimmune disorders including drug-induced lupus. However, data are sparse regarding the prevalence of autoimmune disease in acne or in patients with acne treated with MN.. To establish the prevalence of antinuclear antibodies (ANA), antineutrophil cytoplasmic antibodies (ANCA) and new autoimmune syndromes in an MN-exposed and unexposed population with acne.. In a cross-sectional study, 252 patients with acne vulgaris were assessed. Sixty-nine per cent had been exposed to MN at some point or were taking the drug at the time of the interview. Data recorded included duration of disease (acne) and drug history as well as possible side-effects of drugs, in particular joint symptoms (pain and swelling). In addition, blood was taken for ANA, ANCA, liver function tests and HLA analysis.. There was no statistical difference in the prevalence of ANA positivity between patients exposed (13%) or not exposed (11%) to MN. However, higher titres of ANA (1/160 or higher) were found in the MN-exposed group (45% compared with 12% in the unexposed group). ANCA positivity was found in 7% of the MN-exposed group but no positivity was found in the unexposed cohort (P = 0.022). In 58% of cases, the ANCA detected were of the perinuclear pattern (p-ANCA) with myeloperoxidase specificity, and this finding was associated with clinical symptoms in the majority of cases. Two p-ANCA-positive patients were thought in retrospect to have developed a drug-induced lupus syndrome.. ANA positivity is seen in patients with acne irrespective of exposure to MN; however, p-ANCA appear to be a serological marker for developing autoimmune disease in patients receiving MN.

Topics: Acne Vulgaris; Adolescent; Adult; Aged; Anti-Bacterial Agents; Antibodies, Antineutrophil Cytoplasmic; Antibodies, Antinuclear; Autoimmune Diseases; Cross-Sectional Studies; England; Female; Humans; Lupus Erythematosus, Systemic; Male; Middle Aged; Minocycline

Previous studies have associated tetracyclines and, perhaps more specifically, minocycline use for the treatment of acne with onset of drug-induced lupus erythematosus (LE).. To determine the frequency of LE among those with acne who used antibiotics from the tetracycline class of antibiotics.. A retrospective cohort study of individuals aged 15-35 years with acne within the practices of the general practice physicians in the U.K. who participate in The Health Information Network (THIN). Our outcome measure was physician reports of LE.. We identified 97 694 subjects with acne who were followed for about 520 000 person-years. They were on average about 22 years old and 57.5% were female. Minocycline exposure was noted in 24.8% of our subjects, doxycycline exposure in 15.6%, other tetracyclines in 42.3%, and 17.3% had not received a tetracycline antibiotic. The overall hazard ratio for the association of minocycline to LE was 2.64 (95% confidence interval 1.51-4.66) and when adjusted for age and gender was 3.11 (1.77-5.48). Those affected were often treated for LE. No association was noted for doxycycline and the other tetracyclines.. The use of minocycline and not the other tetracyclines is associated with LE. LE as reported in THIN often required systemic therapy. Overall, the event is uncommon but the risk and benefit of minocycline therapy must be carefully considered.

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Bacterial Agents; Cohort Studies; Female; Humans; Lupus Erythematosus, Systemic; Male; Minocycline; Retrospective Studies; Treatment Outcome

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Diagnosis, Differential; Humans; Lupus Erythematosus, Systemic; Male; Minocycline

A 23-year-old woman with prolonged fever, rash, and pericarditis associated with high titers of antinuclear, anti-Sm, and anti-RNP antibodies was suspected of having systemic lupus erythematosus (SLE). However, we also considered infectious diseases, particularly Q fever, as the C-reactive protein level was elevated and the patient reported contact with zoo animals around two weeks before the onset. The condition responded rapidly to administration of minocycline; symptoms resolved without using steroids. Thereafter, no recurrence of the illness was observed. Titer of Coxiella burnetii antibody was high and the illness was accordingly diagnosed as acute Q fever rather than SLE.

Topics: Adult; Anti-Bacterial Agents; Antibodies, Bacterial; C-Reactive Protein; Cardiomegaly; Coxiella burnetii; Diagnosis, Differential; Drug Therapy, Combination; Female; Humans; Lupus Erythematosus, Systemic; Meropenem; Minocycline; Pericarditis; Q Fever; Radiography; Thienamycins

We report the case of an 18-year-old woman with arthralgia and swelling of distal joints at hands and feet, photosensitive reaction, butterfly rash, fatigue, tachypnea and unspecific cardiac pain three months after beginning a treatment with minocycline for acne. Recurrence of symptoms at a higher intensity occurred within hours of reexposition with minocycline. The antinuclear antibody test was positive. After withdrawal of minocycline, the symptoms improved and minocycline-induced lupus was diagnosed. In the Swissmedic and WHO adverse drug reaction databases 267 other cases of possible minocycline-induced lupus were identified. Typical clinical and laboratory features are arthralgia, arthritis, myalgia, increased transaminases and/or jaundice, unspecific symptoms like fatigue and fever, skin disorders and positive antinuclear antibodies.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Antibodies, Antinuclear; Diagnosis, Differential; Female; Humans; Lupus Erythematosus, Systemic; Minocycline; Time Factors

The tetracycline antibiotic minocycline is widely used in dermatology, but can sometimes cause systemic lupus erythematodes, a serious autoimmune disorder. It is not known how it does this. However, recent data suggest that minocycline can protect cells from apoptosis by inhibition of caspase-dependent and independent cell death pathways. Here, it is suggested that this ability of minocycline is responsible for the induction of lupus. This idea is based on the recent insight that incomplete or failed apoptosis of damaged cells, particularly keratinocytes, may be responsible for the development of auto-immunity. The protection against apoptosis as conferred by minocyclin may be incomplete, with failed apoptosis and development of autoimmunity as a result. Experimental confirmation of the theory may be obtained by in vitro experiments using induction of apoptosis in cell types known to be affected by lupus. Next, mice that are sensitive to apoptosis may be used for in vivo experiments. Novel therapeutic approaches to drug-induced lupus may be based on induction of apoptosis; DNA-damaging immunosuppressive agents appear particularly useful. Such treatments can be tested in apoptosis-deficient mice that develop autoimmune disease.

Topics: Animals; Anti-Bacterial Agents; Apoptosis; Autoimmune Diseases; Caspases; Humans; Lupus Erythematosus, Systemic; Minocycline; Models, Biological; Models, Immunological; Skin Diseases, Bacterial

Nocardial infections in an immunocompromised host have been increasingly reported. Nocardial brain abscess, the most common presentation of nocardiosis in the central nervous system, is associated with a high mortality rate because of its delayed diagnosis and its unresponsiveness to the usual antibiotic therapy. We report four patients who experienced a long-term cure of nocardial brain abscess due to treatment by a combination of surgery and postoperative antibiotic therapy; 1 man and 3 women, ages ranging from 43 to 67 years old. Two patients were associated with systemic lupus erythematosus and two with autoimmune hemolytic anemia. Patients underwent surgical aspiration and drainage of brain abscess. Nocardia was identified from the aspirated specimen and postoperative antibiotic therapy for 5-6 weeks was performed using effective antibiotic agents; sulfamethoxazole/trimethoprim (ST), imipenem/cilastatin and minocycline (MINO) in Case 1, ST and MINO in Case 2, erythromycin in Case 3, and panipenem/betamipron and cefotaxime in Case 4. Case 3 and Case 4 with multilobulated brain abscess underwent total excision of the brain abscess. All patients showed successful cure of nocardial brain abscess with no recurrence for the period of 1-8 years. The combination of surgery and postoperative antibiotic therapy provides a good prognosis for nocardial brain abscess.

Topics: Adult; Aged; Anemia, Hemolytic, Autoimmune; Anti-Bacterial Agents; beta-Alanine; Brain Abscess; Cefotaxime; Cilastatin; Cilastatin, Imipenem Drug Combination; Drainage; Drug Combinations; Drug Therapy, Combination; Female; Humans; Imipenem; Immunocompromised Host; Lupus Erythematosus, Systemic; Male; Middle Aged; Minocycline; Nocardia Infections; Postoperative Care; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adolescent; Adult; Anti-Bacterial Agents; Female; Humans; Lupus Erythematosus, Systemic; Male; Minocycline

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

Minocycline in another drug that can induce drug-induced lupus. Minocycline is frequently used for acne as a prolonged treatment, so it is important to be aware of the risks in this treatment. The risk ratio for the development of lupus due to minocycline is not known, but it seems to be low. We described a 26 year old female who was treated with minocycline due to acne. The treatment was complicated by rash and serological signs of lupus (antinuclear antibodies and anti-DNA antibodies). The aim of this article is to raise the level of awareness of this complication due to minocycline.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Antibodies, Antinuclear; Female; Humans; Lupus Erythematosus, Systemic; Minocycline

Minocycline is one of the major drugs for acne and is effective in rheumatoid arthritis (RA). We describe the first case of drug induced lupus secondary to the use of minocycline in a patient with RA. The dificulties of making this diagnosis as well as the implications for its pathogenesis are discussed.

Topics: Adrenal Cortex Hormones; Aged; Anti-Bacterial Agents; Arthritis, Rheumatoid; Diagnosis, Differential; Diagnostic Errors; Humans; Lupus Erythematosus, Systemic; Male; Minocycline; Treatment Outcome

Peripheral neuropathy in association with minocycline-induced lupus-like reaction has not previously been reported. We present a case of probable minocycline-induced lupus associated with antiphospholipid antibodies and an ulnar neuropathy which has slowly improved since the discontinuation of minocycline.

Topics: Adolescent; Anti-Bacterial Agents; Antibodies, Antiphospholipid; Female; Humans; Lupus Erythematosus, Systemic; Minocycline; Ulnar Neuropathies

To describe the spectrum of clinical features in patients with minocycline-induced lupus (MIL) and determine their response to rechallenge.. The clinical features and laboratory findings of 23 patients with MIL were recorded. Ten patients were rechallenged, and their C-reactive protein (CRP) levels were monitored.. All subjects complained of polyarthralgia; three had metacarpophalangeal and proximal interphalangeal joint synovitis and one had bilateral knee effusions. Elevated hepatic transaminases were noted in eight subjects. Cutaneous vasculitis was a feature in two cases. None had renal or central nervous system disease, although five patients complained of impaired concentration and poor memory and a single patient had a peripheral sensory neuropathy. The following serological abnormalities were detected: antinuclear antibodies (19/23 patients); antibodies to double-stranded DNA (4/23); perinuclear antineutrophil cytoplasmic antibodies (10/15); IgG anti-cardiolipin antibodies (6/23); hypergammaglobulinaemia (12/19). Anti-histone antibodies were negative in 9/9 cases. Rechallenge resulted in rapid recurrence of symptoms and elevation of CRP levels.. MIL is associated with a wide spectrum of clinical and serological features. The diagnosis can be confirmed by rechallenge, which results in rapid reappearance of symptoms and a rise in CRP.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Female; Humans; Lupus Erythematosus, Systemic; Male; Middle Aged; Minocycline; Recurrence

To describe the clinical symptoms and serology of drug-induced lupus in patients treated with the semisynthetic tetracycline derivative, minocycline.. For a 5-year period, all consultant rheumatologists and dermatologists in the West of Scotland were asked to report any suspected cases of a lupus-like syndrome to one center. Twenty cases were identified on the basis of arthritis, positive antinuclear factor and at least one other extraarticular feature following treatment for acne with minocycline. Case histories were reviewed to determine any demographic, clinical, or serological correlations.. Minocycline had been prescribed for a mean of 25 months for the 20 patients identified with drug-induced lupus; 15 were female, 5 were male with a mean age of 24 years. All patients had arthritis and most had at least one other extraarticular feature including lethargy, myalgia, fevers, Raynaud's phenomenon, abdominal pain, and butterfly rash. None had renal involvement. All symptoms resolved at a mean of 15.7 weeks after discontinuation of minocycline treatment.. Minocycline is widely used in the treatment of acne and increasingly in the treatment of rheumatic diseases. Although the absolute risk of developing drug-induced lupus is relatively low, it has been estimated that current use of minocycline is associated with an 8.5 fold increased risk of developing a lupus-like syndrome. Prescribing physicians must be vigilant for any of the characteristic symptoms to avoid unnecessary morbidity, investigations, and therapy.

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Bacterial Agents; Arthritis; Female; Humans; Lupus Erythematosus, Systemic; Male; Minocycline; Scotland; Treatment Outcome

Topics: Adult; Anti-Bacterial Agents; Antibodies, Antinuclear; Female; Humans; Lupus Erythematosus, Systemic; Minocycline; Rosacea; Syndrome

We report 14 patients with minocycline-induced lupus-like syndrome (four men, 10 women; mean age 27.8 years) who developed a lupus-like illness after chronic use of minocycline for acne (1-10 years, median 3.8). Clinical features resolved completely on drug withdrawal (mean follow-up 11 months) and reappeared in two patients who were rechallenged. Sera from all 14 patients contained antineutrophil cytoplasmic antibodies (ANCA) giving a perinuclear pattern on indirect immunofluorescence on ethanol-fixed human neutrophils (p-ANCA), whereas 14 control asymptomatic individuals taking minocycline for acne were ANCA-negative. Eleven of the 14 patients had elevated antimyeloperoxidase antibodies and 10 had antielastase antibodies on enzyme-linked immunosorbent assay, which diminished on extended follow-up, as did other serological abnormalities. Major histocompatibility complex class II typing demonstrated that all of the 13 patients tested were either HLA-DR4 (nine of 13) or HLA-DR2 (four of 13) positive, and all had an HLA-DQB1 allele encoding for tyrosine at position 30 of the first domain. Our findings suggest a model whereby the presence of p-ANCA may be a marker for the development of lupus-like symptoms in genetically susceptible individuals taking minocycline for acne.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Antibodies, Antineutrophil Cytoplasmic; Enzyme-Linked Immunosorbent Assay; Female; Fluorescent Antibody Technique, Indirect; Genetic Markers; Genetic Predisposition to Disease; HLA-DQ Antigens; HLA-DR Antigens; Humans; Lupus Erythematosus, Systemic; Male; Minocycline

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Bacterial Agents; Arthralgia; Arthritis; Case-Control Studies; Cohort Studies; Drug Eruptions; Female; Humans; Lupus Erythematosus, Systemic; Male; Minocycline; Odds Ratio

Minoeycline, a semisynthetic tetracycline, is often used to treat acne and rheumatoid arthritis. It has been considered an unlikely drug to be associated with systemic lupus erythematosus; however, many cases of drug-induced lupus related to minocycline have been reported. Some of those reports included pulmonary lupus, but none of the patients described developed respiratory distress. We describe a patient treated with minocycline for 2 years who presented with progressive dyspnea, severe hypoxia, and pulmonary infiltrates necessitating hospitalization and oxygen supplementation.

Topics: Adolescent; Anti-Bacterial Agents; Female; Humans; Lung; Lung Diseases; Lupus Erythematosus, Systemic; Minocycline; Radiography; Respiratory Insufficiency

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

Topics: Anti-Bacterial Agents; Dyskinesia, Drug-Induced; Humans; Lupus Erythematosus, Systemic; Minocycline

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Diagnosis, Differential; Female; Humans; Lupus Erythematosus, Systemic; Minocycline; Syndrome

Minocycline is widely prescribed for long-term treatment in acne. Major side effects are rare and include hepatitis and drug-related lupus. Hepatitis can be early and acute or late and chronic, whereas lupus presents as a tardive and insidious disease. We report a case of minocycline-induced lupus initially presenting as acute hepatitis, evolving to chronic cytolysis, in a young man treated for facial acne.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Chemical and Drug Induced Liver Injury; Humans; Lupus Erythematosus, Systemic; Male; Minocycline

A young woman developed minocycline-related lupus erythematosus with associated autoimmune hepatitis. All clinical and laboratory abnormalities returned to normal when the drug was stopped. The symptoms worsened dramatically upon rechallenge, strongly suggesting the reaction was related to the minocycline.

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

Topics: Anti-Bacterial Agents; Chemical and Drug Induced Liver Injury, Chronic; Humans; Lupus Erythematosus, Systemic; Minocycline

Topics: Anti-Bacterial Agents; Chemical and Drug Induced Liver Injury; Female; Humans; Lupus Erythematosus, Systemic; Middle Aged; Minocycline

Monocycline is the most widely prescribed systemic antibiotic for acne largely because it needs to be given only once or twice a day and seems not to induce resistance. Up to April 1994 11 cases of minocycline induced systemic lupus erythematosus and 16 cases of hepatitis had been reported to the Committee on Safety of Medicines. An analysis of these cases together with seven other cases shows the severity of some of these reactions. Two patients died while taking the drug for acne and a further patient needed a liver transplant. Acne itself can induce arthritis and is often seen in association with autoimmine liver disease, but the clinical and biochemical resolution seen after withdrawal of the drug, despite deterioration of the acne, suggests a drug reaction. In five cases re-exposure led to recurrence. Because reactions may be severe early recognition is important to aid recovery and also to avoid invasive investigations and treatments such as corticosteroids and immunosuppresants. Safer alternatives should be considered for treating acne.

Topics: Acne Vulgaris; Adult; Aged; Anti-Bacterial Agents; Autoimmune Diseases; Chemical and Drug Induced Liver Injury; Female; Humans; Lupus Erythematosus, Systemic; Male; Minocycline; Syndrome

Topics: Acne Vulgaris; Anti-Bacterial Agents; Autoimmune Diseases; Chemical and Drug Induced Liver Injury; Humans; Lupus Erythematosus, Systemic; Minocycline; Risk Factors

Topics: Acne Vulgaris; Adolescent; Cyproterone Acetate; Drug Therapy, Combination; Ethinyl Estradiol; Female; Humans; Lupus Erythematosus, Systemic; Minocycline

We report a patient who developed symptoms of lupus erythematosus which was apparently related to minocycline therapy for acne vulgaris. To our knowledge, this is only the second reported case of minocycline-associated lupus erythematosus.

Topics: Acne Vulgaris; Adolescent; Female; Humans; Lupus Erythematosus, Systemic; Minocycline

Topics: Adolescent; Female; Humans; Lupus Erythematosus, Systemic; Minocycline

Topics: Acne Vulgaris; Adolescent; Humans; Lupus Erythematosus, Systemic; Male; Minocycline

Five cases of suspected drug-related lupus are described in young female patients who had been taking minocycline for several years. All were asymptomatic before starting treatment. After variable but prolonged periods of continuous therapy all abruptly developed arthralgia/arthritis and on testing were antinuclear factor positive. In four cases the symptoms and signs disappeared within a short time of stopping the drug, whereas in the remaining case the systemic nature of the illness required treatment with corticosteroids. Three patients who were rechallenged with minocycline quickly developed a recurrence of their joint symptoms. Resolution of the serological abnormalities noted in these patients occurred more slowly than the resolution of the clinical symptoms. We propose a direct relationship in these cases between minocycline therapy and the occurrence of a lupus-like syndrome.

Topics: Acne Vulgaris; Adolescent; Female; Humans; Lupus Erythematosus, Systemic; Minocycline; Time Factors

A patient with systemic lupus erythematosus had a protracted skin infection with Mycobacterium marinum after a puffer fish sting. Disseminated cutaneous and synovial disease was associated with clinically active systemic lupus erythematosus two years after the initial infection. The infection was poorly responsive to multiple antituberculous regimens. Hematogenous spread of infection was the likely route of dissemination.

Topics: Adult; Animals; Cellulitis; Female; Fish Venoms; Fishes, Poisonous; Humans; Lupus Erythematosus, Systemic; Minocycline; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Skin Diseases, Infectious; Synovitis; Tendinopathy; Wrist