minocycline and Pleural-Effusion

A 65-year-old man developed respiratory failure with diffuse interstitial shadow, bilateral pleural effusion, and bilateral hilar lymphadenopathy on chest X-ray and CT, after intravenous administration of minocycline. Corticosteroid therapy was effective. The findings from bronchoalveolar lavage (BAL) and transbronchial lung biopsy were compatible with eosinophilic pneumonia. Provocation test supported this diagnosis, but the lymphocyte stimulation test was negative. A review of the literature and the diagnoses of drug-induced pulmonary diseases are discussed.

Topics: Aged; Drug Hypersensitivity; Humans; In Vitro Techniques; Lymphatic Diseases; Lymphocyte Activation; Male; Minocycline; Pleural Effusion; Prednisolone; Pulmonary Eosinophilia

Previously, we have shown rapid and complete dispersion of tetracycline hydrochloride in the pleural space following chest tube instillation. To assess the clinical relevance of this observation, we randomized patients with symptomatic pleural effusions to rotation (R) (n = 19) and nonrotation (NR) (n = 21) groups following administration of tetracycline hydrochloride, 20 mg/kg (n = 30); 300 mg of minocycline hydrochloride (n = 6); and 500 mg of doxycycline hydrochloride (n = 4) through a chest tube. Patients in the R group were maneuvered through six positions for the 2 h that the chest tube remained clamped. The NR patients remained supine for 2 h. Rotation and nonrotation groups were similar in demographics, source of pleural effusion, symptoms, and serum and pleural fluid analyses (all p = NS). A chest radiograph was scored based on pleural fluid recurrence throughout survival or up to 12 months. Survival, duration of chest tube instillation, and success of pleurodesis assessed by radiographic pleural fluid reaccumulation (73.7 vs 61.9 percent; R vs NR) were similar (p = NS). Rotational maneuvers appear to offer no benefit to the success of pleural symphysis after intrapleural instillation of tetracycline class agents.

Topics: Aged; Chest Tubes; Doxycycline; Female; Humans; Instillation, Drug; Male; Middle Aged; Minocycline; Pleura; Pleural Effusion; Posture; Recurrence; Tetracycline

Non-tuberculous mycobacteria cause chronic pulmonary infection, but pleuritis and pleural effusion are rarely associated with infection with non-tuberculous mycobacteria, especially rapid-growing mycobacteria.. A 68-year-old woman with rheumatoid arthritis who was using prednisone, azathioprine, and certolizumab pegol presented complaining of fever, dry cough, and night sweats for the past 2 weeks. Chest examination revealed bilateral opacity that was more pronounced on her right side. Bronchoalveolar lavage fluid and pleural effusion fluid were obtained, and revealed coinfection with Mycobacterium fortuitum and Mycobacterium mageritense. Imipenem/cilastatin, levofloxacin, and minocycline were prescribed for 6 months, and the patient was well and asymptomatic for the subsequent 6 months.. This is the first case report describing pleural effusion associated with coinfection with two different mycobacterial species. If the species cannot be identified, the possibility of mycobacterial coinfection should be considered.

Topics: Aged; Anti-Bacterial Agents; Bronchoalveolar Lavage Fluid; Cilastatin, Imipenem Drug Combination; Coinfection; Female; Humans; Levofloxacin; Minocycline; Mycobacterium fortuitum; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Pleural Effusion

We investigated whether tigecycline (TIGE) is more effective than talc in inducing pleurodesis in rabbits.. Fifty-six New Zealand rabbits were utilized in a two-phase study: Effects at 14 d (phase I) and at 28 d (phase II) were assessed. Saline solution (SAL n = 3), talc slurry (TALC 200 mg/kg, n = 5), and TIGE at different concentrations (mg/kg): TIGE0.5 (n = 5); TIGE1 (n = 5); TIGE3 (n = 5); TIGE25 (n = 5); TIGE50 (n = 5) were randomly injected, for each phase, through a right chest drainage. TIGE0.5 and TIGE1 were ineffective during phase I and were thus excluded from further investigation. At post mortem examination, pleurodesis was graded grossly and microscopically by three observers blinded to treatment groups.. Phase I: pleurodesis was more effective in TIGE25 and TIGE50 (P < 0.001); TALC was better than TIGE0.5 (P < 0.001), and TIGE1 (P = 0.49), macroscopically. Pleural thickness was significantly higher in TIGE25 compared with SAL, TALC, TIGE0.5, TIGE1, and TIGE3 (P < 0.01). No significant differences were evident between TALC and TIGE3, both macroscopically (P = 0.90) and microscopically (inflammation P = 0.99, fibrosis P = 0.96, pleural thickness P = 0.99). Phase II: better effectiveness of TIGE50 compared with all other groups (P < 0.001) except TIGE 25 (P = 0.29); results similar to phase I for TALC and TIGE3 (P = 0.99), macroscopically. Microscopically greater inflammation in TALC compared with TIGE3 (P < 0.05) and in TIGE50 to TIGE3 (P = 0.05). Significant complications occurred in all TIGE50 group. One of TIGE25 and one of TIGE50 died of respiratory distress and of right hemothorax+ascites, respectively.. Intrapleural TIGE3 mg/kg is as effective as talc in inducing pleurodesis in rabbits. The intrapleural TIGE toxicity threshold was reached at TIGE25 mg/kg concentration.

Topics: Animals; Anti-Bacterial Agents; Dose-Response Relationship, Drug; Hemothorax; Incidence; Male; Minocycline; Models, Animal; Pleural Effusion; Pleurodesis; Rabbits; Tigecycline; Treatment Outcome

A 51-year-old man was admitted to our hospital with fever, dry cough and dyspnea. He had taken minocycline for 11 days because of urinary tract infection. Chest X-ray on admission showed diffuse reticular shadows in bilateral lung fields with bilateral pleural effusion. Cessation of minocycline led to spontaneous improvement of symptoms and radiographic findings. The lymphocyte stimulation test for minocycline with peripheral blood and pleural effusion were negative. After provocation test with minocycline, he developed fever and dry cough and bilateral ground glass opacity appeared on his chest X-ray. He was diagnosed as minocycline-induced pneumonitis and recovered rapidly following corticosteroid therapy.

Topics: Anti-Bacterial Agents; Bronchial Provocation Tests; Humans; Lymphocyte Activation; Male; Methylprednisolone; Middle Aged; Minocycline; Pleural Effusion; Pneumonia; Radiography, Thoracic; Treatment Outcome

Topics: Adult; Anti-Bacterial Agents; Humans; Male; Minocycline; Pericardial Effusion; Pleural Effusion; Pulmonary Eosinophilia; Tomography, X-Ray Computed; Treatment Outcome

Extramedullary hematopoiesis is a compensatory process for some hematologic diseases, such as spherocytosis, myelofibrosis and thalassemia. We report a 34-year-old man with beta-thalassemia intermedia who developed intrathoracic extramedullary hematopoiesis with recurrent pleural effusion. Diagnosis of extramedullary hematopoiesis of the pleura and soft tissue was established after thoracoscopic biopsy. Subsequently, the pleural effusion was controlled with intrapleural minocycline instillation. To our knowledge, this is the first case of extramedullary hematopoiesis described in the parietal pleura associated with massive pleural effusion and successfully treated with minocycline.

Topics: Adult; beta-Thalassemia; Hematopoiesis, Extramedullary; Humans; Lung; Male; Minocycline; Pleural Effusion; Pleurodesis; Radiography

The histopathologic findings were compared from 20 mg/kg intrapleural tetracycline hydrochloride (TCN) and three doses of intrapleural minocycline hydrochloride (5, 10, and 20 mg/kg) (MCN) in New Zealand white rabbits. Both TCN and MCN produced an early neutrophilic predominant pleural effusion that became mononuclear over 48 h. There was no difference in pleural fluid accumulation, number of adhesions, or histologically measured visceral and parietal pleural thickness between TCN and MCN (all p = ns). The TCN, 20 mg/kg, produced more visceral pleural plaque than MCN, 5 mg/kg (p < 0.05). Increasing MCN doses resulted in greater pleural fluid neutrophil accumulation. With higher dose MCN, greater mesothelial cell desquamation and fibroblast proliferation was evident compared to the 5 mg/kg dose. The MCN and TCN produce similar histopathologic condition in the rabbit pleura which suggests that MCN should cause a similar clinical response in humans.

Topics: Analysis of Variance; Animals; Minocycline; Pleura; Pleural Effusion; Pleurisy; Rabbits; Tetracycline; Time Factors; Tissue Adhesions

Minocycline pleurodesis with intrapleural pretreatment of lidocaine (150 mg) was performed on 19 patients. Minocycline was instilled into the pleural space for postoperative air leakage in 12 patients and control of malignant pleural effusion in 7 patients. Postoperative air leakage persisted longer than seven days was indicated instillation of minocycline (300 mg) with thoracostomy drainage. Satisfactory results were obtained in 11 of the 12 patients (92%) treated with this method. In 7 patients to control malignant pleural effusion, only one of these patients had recurrence of pleural effusion. Seventeen patients of all 19 subjects were free of pain following pleurodesis. None of these patients had a side effect of lidocaine. In conclusion of instillation, minocycline with thoracostomy drainage is a safe and an effective technique.

Topics: Adult; Aged; Aged, 80 and over; Breast Neoplasms; Drug Evaluation; Female; Humans; Instillation, Drug; Lung Neoplasms; Male; Middle Aged; Minocycline; Pleural Effusion; Pneumonectomy; Pneumothorax; Postoperative Complications; Tetracyclines; Thorax

In order to investigate the possible mechanism for the therapeutic efficacy of tetracycline antibiotics against malignant pleural effusion, the effect of minocycline (MC), one of this type of antibiotic, on in vitro growth of tumor cells was examined. As a result, it was found that MC caused complete growth inhibition of various tumor cell lines at concentration of 10-20 micrograms/ml, but this action was reversible, suggesting that considerably long exposure time would be needed for these drugs to kill the tumor cells in vivo at a relatively low concentration. On the other hand, when a relatively high concentration of 100 micrograms/ml was applied, MC induced irreversible inhibition of cell growth even if the exposure time was comparatively short. Since 4 human lung tumor cell lines examined exhibited high sensitivity to these antibiotics, it seems possible that their direct administration in the form of a high-concentration solution into the pleural cavity would result in a direct cytostatic effect on tumor cells in clinical therapy.

Topics: Animals; Cell Division; Cell Line; Cell Survival; Cells, Cultured; Humans; Leukemia L1210; Leukemia P388; Leukemia, Experimental; Lung Neoplasms; Mice; Minocycline; Pleural Effusion; Tetracyclines

Two cases of Noca dia asteroides infection were encountered out of 55 kidney transplant patients at Chiba University Hospital. One patient developed an extrapleural abscess and the other had a pulmonary infiltration with chest wall abscess. The patients were successfully treated by surgical drainage of the chest wall abscesses and by oral administration of minocycline. No adverse effects caused by minocycline were observed during the therapy. From 1900, when the first case of Nocardia infection was reported in Japan, there have been 60 cases reported in Japanese literature through 1973, including those we observed. This is the first report on nocardiosis in kidney transplant patients and on successful treatment of nocardiosis with minocycline in Japan.

Topics: Abscess; Adult; Glomerulonephritis; Humans; Kidney Transplantation; Male; Minocycline; Nocardia asteroides; Nocardia Infections; Pleural Effusion; Postoperative Complications; Tetracyclines; Transplantation, Homologous

Minocycline concentrations in serum, saliva, sputum, pleural exudate and lung extracts after a single dose of 0.2 g (orally or intravenously) were measured on 32 patients with bronchial or lung disease. On the first day of treatment, concentrations in purulent sputum were five to ten times higher than in mucous sputum and saliva, after two hours they were one third, after three hours half the serum concentration (0.7 and 1.0 microgram/ml, respectively). After six hours the concentration was the same (1.6 microgram/ml). On the third day of treatment (after 0.2 g every 24 hours) concentrations in purulent sputum were higher than on the first day by 0.8 microgram/ml (after two hours) and by 0.95 microgram/ml (after three hours). After one-hour i.v. infusion of 0.2 g minocycline concentrations in mucous sputum and saliva rose more quickly on the first day than after oral administration. On the third day of treatment (after 0.1 g orally every 12 hours) pleural exudate level was almost as high as serum level. Minocycline concentration in lung extract on the third day of treatment--four, five and ten hours after the last dose--was 0.4 and 0.8 microgram/g, respectively (while serum concentration at the same time was 1.0-1.5 microgram/ml).

Topics: Humans; Lung; Minocycline; Pleural Effusion; Respiratory Tract Infections; Saliva; Sputum; Tetracyclines; Time Factors