minocycline and Pseudotumor-Cerebri

Tetracyclines are a class of broad-spectrum bacteriostatic antibiotics used to treat many infections, including methicillin-resistant Staphylococcus aureus (MRSA), acne, pelvic inflammatory disease, chlamydial infections, and a host of zoonotic infections. These drugs work by inhibiting protein synthesis in bacterial ribosomes, specifically by disallowing aminoacyl-tRNA molecules from binding to the ribosomal acceptor sites. While rare, tetracycline antibiotics, particularly minocycline and doxycycline, are associated with an increased risk of developing esophageal perforation and pseudotumor cerebri (PTC, or idiopathic intracranial hypertension). Since tetracyclines are a commonly prescribed class of medications, especially in adolescents for acne treatment, it is important for clinicians to appreciate significant side effects that can result in morbidity and mortality. This paper aims to consolidate and to emphasize current research on the association between tetracycline antibiotics and the development of esophageal perforation, and PTC. PTC is a neurological syndrome consisting of increased intracranial pressure, headache, and vision changes without evidence of the contributing source, such as mass lesion, infection, stroke, or malignancy. Esophageal perforation, while rare, can be the result of pill esophagitis. Pill-induced injuries occur when caustic medicinal pills dissolve in the esophagus rather than in the stomach. Most patients experience only self-limited pain (retrosternal burning discomfort, heartburn, dysphagia, or odynophagia), but hemorrhage, stricture, and perforation may occur. Tetracycline use can lead to pill esophagitis. In summary, clinicians should appreciate the potential risks of tetracycline compounds in clinical practice.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Doxycycline; Esophageal Perforation; Esophagitis; Humans; Methicillin-Resistant Staphylococcus aureus; Minocycline; Pain; Pseudotumor Cerebri; Tetracycline

Topics: Adolescent; Female; Humans; Intracranial Hypertension; Intracranial Pressure; Minocycline; Optic Atrophy; Papilledema; Pseudotumor Cerebri; Vision Disorders

Cycline antibiotics (CAs) are commonly used to treat acne, blepharitis, and dry eye syndrome. Prescribers or patients may hesitate to use Cas because they may increase the risk of pseudotumor cerebri syndrome (PTCS).. We sought to assess whether CA use is associated with an increased risk of PTCS or papilledema and whether the risk depends upon dosage or duration of CA intake.. We studied patients 12 to 65 years of age who were diagnosed with acne, blepharitis, or dry eye syndrome, who were enrolled in a nationwide managed care network between January 1, 2001 and December 31, 2015, and who had no preexisting diagnosis of papilledema or PTCS. Multivariable Cox regression modeling was used to assess the risk of developing papilledema or PTCS from exposure to CAs.. Among the 728,811 eligible enrollees (mean age, 34.7 years; 72% female), 42.0% filled ≥1 CA prescription. Of the 305,823 CA users, 170 (0.06%) were diagnosed with papilledema or PTCS. By comparison, of the 57.0% with no record of CA use, 121 (0.03%) were diagnosed with papilledema or PTCS (P < .0001). In the unadjusted model, every additional year of CA use was associated with a 70% (doxycycline: hazard ratio, 1.70 [95% confidence interval 0.98-2.97]; P = .06) or 91% (minocycline: hazard ratio, 1.91 [95% confidence interval 1.11-3.29]; P = .02) increased hazard of papilledema/PTCS relative to nonusers of CAs. After adjustment for confounders, the increased hazard of PTCS/papilledema with CA use was no longer statistically significant (P = .06, doxycycline; P = .08, minocycline).. This study relies on claims data, which lack clinical data.. This study offers some evidence that CAs may increase the risk of PTCS/papilledema. However, after accounting for confounding factors in our multivariable models, we found no statistically significant association between CA use and the development of PTCS. Moreover, there was no dose-response effect whereby greater CA use was associated with a higher PTCS risk.

Topics: Acne Vulgaris; Administrative Claims, Healthcare; Adolescent; Adult; Anti-Bacterial Agents; Blepharitis; Doxycycline; Dry Eye Syndromes; Female; Humans; Male; Middle Aged; Minocycline; Papilledema; Pseudotumor Cerebri; Young Adult

Topics: Acne Vulgaris; Administration, Oral; Adolescent; Adult; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Resistance; Drug Therapy, Combination; Female; Humans; Isotretinoin; Minocycline; Pseudotumor Cerebri; Recurrence

Pseudotumor cerebri is a syndrome characterized by an elevated intracranial pressure greater than 20 cmH2O with ventricles and cerebrospinal fluid of normal characteristics. Consumption of minocycline have been described among the causes associated with this syndrome. We present a 13-year old female patient with a history of acne treated with minocycline who began with severe headache, diplopia and blurred vision. The diagnosis of pseudotumor cerebri was made, indicating the immediate antibiotic suspension and the beginning of the treatment with acetazolamide. Although the pathogenesis of pseudotumor cerebri is not fully known, an association with minocycline has been observed. This antibiotic is often used by health professionals for the management of acne, so it is important to consider its complications before being prescribed.. El pseudotumor cerebral se caracteriza por una elevación de la presión intracraneal mayor de 20 cmH2O, con ventrículos y líquido cefalorraquídeo de características normales. El consumo de minociclina es una de las causas asociadas a este síndrome. Presentamos una paciente de 13 años de edad con antecedentes de acné tratado con minociclina. Comenzó con cefalea intensa, diplopía y visión borrosa. Se constató el diagnóstico de pseudotumor cerebral y se indicó la suspensión inmediata del antibiótico y el inicio del tratamiento con acetazolamida. Aunque la patogénesis de pseudotumor cerebral no es totalmente conocida, se ha observado una asociación con el empleo de minociclina. Este antibiótico es de uso frecuente para el manejo del acné, por lo que es importante considerar sus complicaciones antes de ser prescrito.

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Female; Humans; Minocycline; Pseudotumor Cerebri

Topics: Adolescent; Female; Humans; Magnetic Resonance Imaging; Minocycline; Pseudotumor Cerebri; Spinal Puncture

We present three cases of rare side effects which appeared to be attributable to antibacterial drug treatment. A 57-year-old female patient was admitted to hospital due to increasing dyspnea. Computed tomography revealed interstitial lung fibrosis which was attributed to the toxic effects of nitrofurantoin (50 mg/d) that the patient used for approximately one year for recurrent urinary tract infection. She died two weeks after hospital admission due to acute respiratory failure. A 20-year-old male patient presented with most intense headache and psychomotor deceleration. Pseudotumor cerebri, which was suspected to be the underlying cause, is described as a rare side effect of minocyclin which the patient has taken for acne pustulosa (100 mg single dose). After dechallenge of minocyclin, neurological symptoms quickly subsided. A 82-year-old female patient used moxifloxacin (400 mg/d) for febrile bronchopulmonary infection for one week. During this therapy, confusion and severe dementia presented and remained for more than two months after discontinuation. The demential syndrome appears to be possibly related to the fluoroquinolone use. In summary, adverse drug effects not pertaining to the primary physician's field are especially difficult to identify. Most importantly, rare side effects must be borne in mind by the prescribing physician.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Anti-Infective Agents; Anti-Infective Agents, Urinary; Aza Compounds; Dementia; Female; Fluoroquinolones; Humans; Male; Middle Aged; Minocycline; Moxifloxacin; Nitrofurantoin; Pseudotumor Cerebri; Pulmonary Fibrosis; Quinolines; Young Adult

Topics: Acetazolamide; Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Carbonic Anhydrase Inhibitors; Female; Humans; Minocycline; Pseudotumor Cerebri

To demonstrate the association between tetracycline treatment and pseudotumor cerebri (PTC).. Consecutive patients from two neuro-ophthalmic referral centers, who developed PTC syndrome post-treatment with tetracycline, were enrolled and followed for a minimum of 2 years after cessation of tetracycline.. A total of 243 consecutive patients were diagnosed with PTC; 18 had concurrent history of tetracycline treatment; a third experienced a limited course of illness with no relapses; 12 had a variable course with a prolonged relapsing illness. Mean duration of tetracycline treatment prior to diagnosis was 2.73 months.. Tetracycline, and especially minocycline, is currently considered a cause or a precipitating factor for PTC. Although there is little information on the natural course of tetracycline induced PTC, the present cases demonstrate that drug withdrawal is curative only in some patients.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Female; Humans; Male; Minocycline; Prognosis; Pseudotumor Cerebri; Retrospective Studies; Risk Factors; Tetracycline; Vision Disorders

Topics: Abdominal Pain; Adolescent; Anti-Bacterial Agents; Back Pain; Diagnosis, Differential; Diplopia; Emergency Nursing; Female; Humans; Medical History Taking; Minocycline; Nausea; Nursing Assessment; Physical Examination; Pseudotumor Cerebri

We report two cases of bilateral papilledema in young women. The first patient was 15 years old and had experienced headaches and vomiting for one month, but no visual loss. Cerebral tomodensitometry results were normal, but lumbar puncture showed increased pressure and normal biology. Benign intracranial hypertension was diagnosed. Recent treatment with minocycline for acne vulgaris was the only etiology. Papilledema was totally regressed at 6 weeks, after interruption of the antibiotic treatment. A prescription of acetazolamide was added for a short period of 10 days. The second patient, aged 29 years, presented bilateral papilledema with severe visual loss, with vision limited to light perception with mydriasis of the right eye. Lumbar puncture was not indicated because of a hypophyseal microadenoma revealed on MRI investigation. No other associated abnormalities were observed, in particular, no cerebral sinus thrombosis. Corticotherapy using prednisolone for 72 hours had no clinical effect. Fast visual recovery was obtained with intravenous acetazolamide therapy and was completely resolved at 2 months. Right visual field defects persisted. Minocycline and obesity are recognized as precipitating factors in pseudotumor cerebri syndrome. The literature advocates consideration of surgical treatment by optic nerve sheath fenestration if antiedematous treatment has no effect and the eye is nearly blind.

Topics: Acetazolamide; Adolescent; Adult; Anti-Bacterial Agents; Carbonic Anhydrase Inhibitors; Female; Fluorescein Angiography; Follow-Up Studies; Humans; Injections, Intravenous; Intracranial Hypertension; Minocycline; Obesity; Papilledema; Pseudotumor Cerebri; Time Factors; Visual Acuity

Topics: Acetazolamide; Acne Vulgaris; Child; Drug Information Services; Drug Labeling; Humans; Internship and Residency; Male; Minocycline; Pediatrics; Periodicals as Topic; Pseudotumor Cerebri

Pseudotumor cerebri or benign intracranial hypertension is a syndrome of raised intracranial pressure without obvious explanation. Most patients are obese women at childbearing age. Symptoms and signs usually include headache, nausea, vomiting, edema of the papilla, visual obscurations and rarely palsy of the nervus abducens. The prognosis is generally good, but progressive visual loss and eventual blindness are major risks. We report the case of a 21-year-old non-obese young woman who developed pseudotumor cerebri while taking minocycline for acne therapy. Identical symptoms occurred upon inadvert rechallenge with minocycline for the second time.

Topics: Acne Vulgaris; Adult; Diagnosis, Differential; Female; Humans; Minocycline; Pseudotumor Cerebri

Topics: Adolescent; Anti-Bacterial Agents; Female; Humans; Minocycline; Pseudotumor Cerebri

To demonstrate the association between minocycline treatment and development of the pseudotumor cerebri syndrome.. A retrospective study was conducted of 12 patients from five neuro-ophthalmic referral centers who developed pseudotumor cerebri syndrome after being treated with standard doses of minocycline for refractory acne vulgaris. The main outcome measures included resolution of headaches, transient visual obscurations, diplopia, papilledema, and visual fields static thresholds after withdrawal of minocycline and treatment for increased intracranial pressure.. Nine (75%) of the 12 patients developed symptoms of the pseudotumor cerebri syndrome syndrome within 8 weeks of starting minocycline therapy; six were not obese. Two patients developed symptoms only after a year had elapsed because of commencement of treatment with minocycline. One patient was asymptomatic, and pseudotumor cerebri syndrome was diagnosed by finding papilledema on routine examination 1 year after minocycline was started. None of the patients developed recurrences for at least 1 year after the discontinuation of minocycline and treatment for increased intracranial pressure, but three (25%) of the 12 patients had substantial residual visual field loss.. Minocycline is a cause or precipitating factor in pseudotumor cerebri syndrome. Although most patients have prominent symptoms and are diagnosed promptly, others are asymptomatic and may have optic disk edema for a long period of time before diagnosis. Withdrawal of minocycline and treatment for increased intracranial pressure lead to resolution of the pseudotumor cerebri syndrome, but visual field loss may persist.

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Bacterial Agents; Diplopia; Female; Follow-Up Studies; Headache; Humans; Intracranial Pressure; Minocycline; Papilledema; Pseudotumor Cerebri; Retrospective Studies; Syndrome; Vision Disorders; Visual Acuity

A 15-year-old girl, who had been treated with minocyclin for acne for 2 months, was admitted for investigation of headache, nausea and papilledema. A space-occupying lesion was ruled out by computerized brain tomography. The diagnosis of benign intracranial pressure (pseudo-tumor cerebri) was made because of elevated cerebrospinal fluid pressure with normal biochemistry and cytology. Tetracyclines, especially minocyclin, commonly used for treating acne in adolescents, can cause benign intracranial pressure.

Topics: Acetazolamide; Adolescent; Anti-Bacterial Agents; Diuretics; Female; Headache; Humans; Minocycline; Nausea; Papilledema; Pseudotumor Cerebri

Topics: Acne Vulgaris; Adolescent; Anti-Bacterial Agents; Female; Humans; Minocycline; Pseudotumor Cerebri

A 16-year-old girl complained about a headache of one-month's duration, accompanied by vertical diplopia that had appeared ten days earlier. The girl reported receiving vitamin A and minocycline to treat acne vulgaris for the previous six weeks. An examination revealed bilateral optic disc edema. Normal computed tomographic and magnetic resonance imaging examinations enabled a diagnosis of pseudotumor cerebri to be made. Soon after discontinuation of those medications, the headaches and diplopia diminished. We suggest a periodic ophthalmologic examination during systemic therapy with vitamin A combined with minocycline to detect the early occurrence of pseudotumor cerebri.

Topics: Acne Vulgaris; Adolescent; Diplopia; Drug Therapy, Combination; Female; Fundus Oculi; Headache; Humans; Magnetic Resonance Imaging; Minocycline; Papilledema; Pseudotumor Cerebri; Tomography, X-Ray Computed; Vitamin A

A 16-year-old girl developed headaches and bilateral papilledema while taking minocycline for acne. The initial neuro-ophthalmologic evaluation was normal except for enlarged blind spots OU. An MRI scan demonstrated subtle abnormalities. A lumbar puncture was entirely normal except for an increased opening pressure. A tentative diagnosis of pseudotumor cerebri was made and the patient was treated with Diamox. A second MRI was unchanged, and a lumbar puncture performed while the patient was taking Diamox was entirely normal. The patient subsequently lost vision in both eyes, and a third MRI now revealed a supracellar enhancing mass. Biopsy and subtotal resection of the mass showed it to be a glioblastoma multiforme. This case emphasizes pitfalls in the diagnosis of pseudotumor cerebri. Careful follow-up and a high index of suspicion in pseudotumor cerebri syndromes are essential.

Topics: Adolescent; Brain Neoplasms; Diagnosis, Differential; Female; Fundus Oculi; Glial Fibrillary Acidic Protein; Glioblastoma; Humans; Magnetic Resonance Imaging; Minocycline; Papilledema; Pseudotumor Cerebri; Visual Fields

A case is reported of a 16-year-old girl who developed benign intracranial hypertension, with severe bilateral papilledema after minocycline therapy. A lumboperitoneal bypass was carried out in view of the ophthalmologic signs and the pressure of cerebrospinal fluid.

Topics: Adolescent; Female; Humans; Minocycline; Pseudotumor Cerebri

Topics: Acne Vulgaris; Female; Humans; Isotretinoin; Minocycline; Pseudotumor Cerebri

Topics: Adolescent; Female; Humans; Minocycline; Pseudotumor Cerebri; Tetracyclines

A case of pseudo-tumor cerebri is reported in a woman being treated with minocycline and tretinoin for acne who also ingested liver as a self-treatment for her condition. A possible cumulative effect between these agents is postulated.

Topics: Acne Vulgaris; Adult; Female; Humans; Minocycline; Pseudotumor Cerebri; Tretinoin

Four cases of benign intracranial hypertension (BIH) associated with minocycline therapy are described. All subjects were young women being treated for acne. The durations of therapy from the onset of minocycline treatment until the diagnosis of BIH was made were 25 days, 4 weeks, 4 months and 18 months. Headache was severe in all cases. Two had intermittent visual obscurations. Papilloedema was present in each case. CT brain scans did not show any focal abnormalities other than the presence of small ventricles. Cessation of minocycline reversed the disease process though the resolution was much slower in the patient with the longest history of minocycline intake. One subject still had persisting lower nasal quadrantic field loss 6 months after cessation of minocycline. In each case the diagnosis of benign intracranial hypertension related to minocycline was not made by the primary referring doctor, indicating the need for increased awareness of this cause of headache.

Topics: Acne Vulgaris; Adolescent; Female; Humans; Minocycline; Papilledema; Pseudotumor Cerebri; Tetracyclines

A 19 year-old woman complained of headache and nausea occurring while she was taking minocycline for acne. Examination showed bilateral papilloedema and a bilateral VIth nerve palsy. Symptoms and signs rapidly resolved after the drug was stopped. Benign intracranial hypertension due to tetracyclines is well known in infants. It is rare in adults. Its pathophysiology remains unknown. The role of vitamin A is inconsistent. Others biological factors or personal susceptibility could be involved.

Topics: Acne Vulgaris; Adult; Female; Humans; Minocycline; Pseudotumor Cerebri; Tetracyclines

A case of pseudotumour cerebri (PTC) in a 13-year-old girl is reported. This patient experienced menarche seven months before presentation, and subsequently developed acne which necessitated antibiotic therapy. She had been treated with minocycline hydrochloride (100 mg twice a day) for two months before admission to hospital. The role of minocycline therapy associated with menarche in the aetiology of PTC is discussed.

Topics: Acne Vulgaris; Adolescent; Female; Humans; Menstruation Disturbances; Minocycline; Pseudotumor Cerebri; Tetracyclines

A case is reported of a young girl who developed benign intracranial hypertension, with severe bilateral papiledema and a left sixth cranial nerve palsy, after minocylcine therapy. This drug is a semisynthetic tetracycline which has proven to pass into the CSF more effectively and to have a greater lipoid solubility than the other antibiotics of the same group.

Topics: Abducens Nerve; Adolescent; Female; Humans; Intracranial Pressure; Minocycline; Papilledema; Paralysis; Pseudotumor Cerebri; Tetracyclines

Topics: Adolescent; Female; Humans; Minocycline; Pseudotumor Cerebri; Tetracyclines