minocycline and Pulmonary-Eosinophilia

Minocycline is a tetracycline antibiotic that is widely used to treat infections and is a first-line oral antibiotic in the treatment of moderate to severe inflammatory acne. Although it has high efficacy, several adverse reactions, including life-threatening ones, have been reported in association with its use.. To identify all the potential adverse reactions due to minocycline and analyze them in terms of the number of cases reported so far, salient features, severity and clinical outcome.. Comprehensive PubMed search of English and non-English literature for case reports of adverse reactions to minocycline was conducted.. A total of 550 cases were identified from over 200 publications. The major reported adverse events caused by minocycline are drug reaction with eosinophilia and systemic symptoms syndrome, autoimmune syndromes like hepatitis, lupus and vasculitis, acute eosinophilic pneumonia, pseudotumor cerebri, hyperpigmentation, serum sickness-like reaction, Sweet's syndrome and drug fever. Several other reactions involving multiple organ systems have also been reported. These show an overlap of clinical features and may be associated with multiple events causing considerable morbidity. Eight of these cases resulted in the death of the patients.. In view of the evident potential of minocycline to cause long-lasting and severe adverse effects, significant morbidity and even mortality, it should be prescribed with caution in the first-line treatment for moderate to severe acne.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Humans; Minocycline; Pulmonary Eosinophilia

Eosinophilic pneumonia (EP) is an important subset of patients who present with pulmonary infiltrates and eosinophilia (PIE). EP is classified by chronicity and etiology and drug-induced EP is the main cause of secondary EP. The primary goal of this review was to examine all the case reports published since the syndrome was defined in 1990. It remains unclear whether acute or chronic EP (AEP or CEP) represent different diseases, and the secondary goal of this review is to determine if there are factors that may help distinguish these 2 entities.. PubMed (MEDLINE and Medical Subject Headings) was searched for case reports of drug-induced EP or PIE syndrome published between 1990 and 2017. Case reports were only included if the diagnostic criteria for AEP or CEP were fulfilled. For each case, data were extracted pertaining to age, sex, type of medication associated with the disease, time from the onset of symptoms to diagnosis, eosinophil counts in the blood, eosinophil fractions in bronchoalveolar lavage (BAL) fluid, initial chest radiograph and computed tomography results, use of mechanical ventilation, and use of steroid treatment and recurrence.. We found 196 case reports describing drug-induced EP. The leading cause was daptomycin. From our review, we found that AEP is more common in younger patients with no gender preference. Eosinophilia in the blood at the time of diagnosis characterized only the CEP patients (80% in CEP vs. 20% in AEP). Abnormal findings on radiographic imagine was similar in both syndromes. A significant portion of AEP patients (20%) presented with acute respiratory failure requiring mechanical ventilation. Most patients with EP were treated with steroids with a higher rate of relapse observed in patients with CEP.. AEP is a much more fulminant and severe disease than the gradual onset and slowly progressive nature of CEP. The pathogenesis of AEP and CEP remains unclear. However, there is significant clinical overlap among AEP and CEP that are associated with drug toxicity, suggesting the possibility that AEP and CEP are distinct clinical presentations that share a common pathogenic pathway.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Chronic Disease; Daptomycin; Eosinophils; Female; Humans; Male; Mesalamine; Middle Aged; Minocycline; Pulmonary Eosinophilia; Sulfasalazine

A 45-year-old man was admitted with a severe dry cough and fever. He had been given 100 mg/day of minocycline and other drugs for 9 days to treat hematopyuria. Chest X-ray film showed multiple nodular shadows with diffuse reticular shadows. After all the drugs were discontinued, the fever and the shadows improved, but the severe dry cough persisted. The day 4 bronchofiberscopic findings included multiple white plaques in the tracheobronchial mucosa. Punch biopsy specimens obtained from the white plaques revealed severe eosinophil infiltration, and the eosinophil count in the bronchoalveolar lavage fluid had increased (differential count 23%). After three days of 125 mg/day of methylprednisolone sodium succinate injection therapy, the severe cough, the X-ray shadows and the white plaques disappeared. With a positive result in the lymphocyte migration inhibition test, the patient's condition was diagnosed as minocycline-induced eosinophilic pneumonia.

Topics: Anti-Bacterial Agents; Bronchi; Cell Migration Inhibition; Humans; Lymphocyte Activation; Male; Middle Aged; Minocycline; Pulmonary Eosinophilia; Respiratory Mucosa; Trachea

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

Topics: Acne Vulgaris; Adult; Drug Hypersensitivity; Female; Humans; Minocycline; Pulmonary Eosinophilia

A 22-year-old patient was hospitalized for severe acute eosinophil pneumonia imputable to treatment with minocyclin chlorhydrate (Mynocine). Clinical manifestations began one week after onset of drug intake. The clinical picture included fever at 38 degrees C, polypnoea at 44/min, pulmonary crepitation and severe hypoxia at 4.5 kPa. Eosinophil blood counts were high (3.02 x 10(9)/l) Standard chest X-ray led to the diagnosis of eosinophil pneumonia. Approximately 50% of the polynuclears were eosinophils. The clinical course was rapidly favourable after withdrawal of minocyclin and administration of corticosteroids. This case was analysed and compared with other reports of minocylin induced pneumonia.

Topics: Acute Disease; Adult; Female; Humans; Minocycline; Pulmonary Eosinophilia

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

A 37-year-old woman presenting with high fever, dry cough and progressive dyspnea was admitted to our hospital. She took 100 mg of minocycline hydrochloride orally because of a common cold one day prior to her admission. A chest CT scan showed diffuse ground-glass opacities with interlobular septal thickening and thickening of bronchovascular bundles. An analysis of bronchoalveolar lavage fluid showed an increase in both the total cell counts and the number of eosinophils. The result of a lymphocyte stimulation test performed on peripheral blood lymphocytes was positive for minocycline. This patient had a history of pneumonia with similar clinical and radiographic findings, which had developed while receiving minocycline. As a result, we made a diagnosis of minocycline-induced acute eosinophilic pneumonia. Her symptoms and radiographic findings improved within a few days after admission. Corticosteroid therapy was effective. A marked increase of peripheral blood neutrophils were noted on admission. The serum levels of IL-8 and G-CSF increased at the early phase of the disease, but thereafter decreased in association with neutrophils, thus suggesting the contribution of these cytokines to the early phase neutrophilia in this case.

Topics: Acute Disease; Adult; Female; Granulocyte Colony-Stimulating Factor; Humans; Interleukin-8; Leukocytosis; Minocycline; Neutrophils; Prednisolone; Pulmonary Eosinophilia; Treatment Outcome

We reported a case of acute eosinophilic pneumonia (AEP) induced by minocycline. A 55-year-old man presented with a low grade fever and cough and was treated with antibiotics, including minocycline (MINO). During treatment, the patient developed symptoms of acute respiratory failure, and computed tomography (CT) scan showed bilateral ground grass opacities. Bronchoalveolar lavage (BAL) was performed. The percentage of eosinophils in the BAL fluid was elevated (66%). The patient was treated with methylprednisolone under a diagnosis of AEP. Immediately after initiation of therapy, the CT film findings and clinical symptoms improved. Although a drug-induced lymphocyte stimulation test for MINO was negative, we speculated that AEP was caused by MINO in this case.

Topics: Acute Disease; Anti-Bacterial Agents; Bronchoalveolar Lavage; Humans; Lymphocyte Activation; Male; Methylprednisolone; Middle Aged; Minocycline; Pulmonary Eosinophilia; Tomography, X-Ray Computed; Treatment Outcome

We report an instructive case of minocycline-induced eosinophilic pneumonia confirmed by re-challenge test, in which a preceding lymphocyte-stimulation test indicated acetaminophen as the etiologic agent. A 55-year-old woman developed high fever and lung infiltrates with pulmonary eosinophilia after exposure to minocycline, acetaminophen, theophylline and procaterol. All of the medicines were discontinued, resulting in prompt improvement. The lymphocyte stimulation tests provided a positive result for acetaminophen, but not for the other medicines; however, a negative result was given by a re-challenge test with acetaminophen. In contrast, symptoms and hypoxemia reappeared when minocycline was re-administered. We would like to emphasize that lymphocyte stimulation test results need to be carefully interpreted for individual drugs.

Topics: Acetaminophen; Acute Disease; Analgesics, Non-Narcotic; Anti-Bacterial Agents; False Negative Reactions; False Positive Reactions; Female; Humans; Hypoxia; Immunologic Techniques; Lymphocyte Activation; Middle Aged; Minocycline; Pulmonary Eosinophilia; Radiography, Thoracic; Tomography, X-Ray Computed

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

The antibiotic minocycline, which is used in the treatment of acne, has been associated with various pulmonary complications such as pulmonary lupus and hypersensitivity pneumonitis. We now report a particularly severe case of minocycline-related pulmonary toxicity that was characterized by a relapsing form of hypersensitivity eosinophilic pneumonia complicated by acute respiratory failure.

Topics: Acne Vulgaris; Acute Disease; Administration, Oral; Anti-Bacterial Agents; Female; Humans; Middle Aged; Minocycline; Pulmonary Eosinophilia; Recurrence; Respiratory Insufficiency

Eosinophilic pneumonia is a rare adverse effect of minocycline. To date there are about 70 chemical compounds that cause drug-induced, eosinophilic lung disease. A 20-year-old woman who developed eosinophilic pneumonia due to minocycline is described. Diagnosis was established by history, signs and symptoms, peripheral eosinophilia, chest x-rays and response to combined cessation of treatment and a short course of steroids. Physicians should be aware to this rare adverse effect of the drug. Attention to the possibility of minocycline-induced eosinophilic pneumonia can prevent unnecessary, expensive investigation. Cessation of intake is usually sufficient for cure.

Topics: Adrenal Cortex Hormones; Adult; Anti-Bacterial Agents; Female; Humans; Minocycline; Pregnancy; Pulmonary Eosinophilia

To report a severe and unusual reaction to minocycline and the use of in vitro immunologic assays.. A 46-year-old white man developed severe respiratory distress with pulmonary infiltrates on chest X-ray and eosinophilia in blood, bronchoalveolar lavage fluid, and biopsied lung tissue during exposure to minocycline. Additional manifestations included pleuropericardial effusion, liver function abnormality, and bone marrow eosinophilia. Macrophage inhibition factor and mast cell degranulation assays were positive to minocycline.. The patient's manifestations were compatible with the diagnosis of eosinophilic pneumonia. After excluding other possible etiologies, minocycline was identified as the offending agent. Generalized damage was suggested by the presence of a combination of extrapulmonary manifestations previously not reported. Results of the in vitro immunologic assays supported the hypersensitivity nature of the disease and confirmed the diagnosis.. Minocycline-induced eosinophilic pneumonia may involve extrapulmonary sites. It is suggested that in vitro immunoassays be used for confirmation of the diagnosis rather than rechallenge or invasive procedures.

Topics: Anti-Bacterial Agents; Cell Degranulation; Humans; Immunoassay; Macrophage Migration-Inhibitory Factors; Male; Mast Cells; Middle Aged; Minocycline; Pulmonary Eosinophilia

We studied the clinical features of minocycline-induced pneumonitis in seven patients. Acute symptoms included fever, dry cough and dyspnea, indicating acute respiratory failure. Diffuse ground glass shadows with Kerley's B lines, bronchial wall thickening, swelling of vascular bundles and pleural effusion were visible on radiography. Bronchoalveolar lavage or transbronchial lung biopsy confirmed pulmonary eosinophilia. Cessation of minocycline led to rapid remission with no treatment or only short-term steroid therapy. The lymphocyte stimulation test for minocycline with peripheral blood lymphocytes was not found to be useful for diagnosis.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Alveolitis, Extrinsic Allergic; Anti-Bacterial Agents; Biopsy; Blood Gas Analysis; Bronchoalveolar Lavage; Bronchoalveolar Lavage Fluid; C-Reactive Protein; Female; Humans; Immunoglobulin E; Leukocyte Count; Male; Minocycline; Pharyngitis; Pulmonary Eosinophilia; Tomography, X-Ray Computed

Topics: Acute Disease; Adolescent; Anti-Bacterial Agents; Female; Humans; Minocycline; Pulmonary Eosinophilia

We report a case of eosinophilic pneumonia secondary to taking Tetracycline whose severity required the use of mechanical ventilation and steroid therapy. On the basis of this case, we review the characteristics of drug-induced pneumonia as well as the differential diagnosis which are evoked.

Topics: Adult; Anti-Bacterial Agents; Anti-Inflammatory Agents; Diagnosis, Differential; Humans; Hydrocortisone; Male; Minocycline; Pulmonary Eosinophilia; Respiration, Artificial

Topics: Acne Vulgaris; Adult; Female; Humans; Minocycline; Pulmonary Eosinophilia; Radiography

Topics: Aged; Gallium Radioisotopes; Humans; Lung; Male; Minocycline; Pulmonary Eosinophilia; Radiography, Thoracic; Radionuclide Imaging

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

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

Topics: Adult; Female; Humans; Minocycline; Pulmonary Eosinophilia

A rare side effect of minocycline is acute eosinophilic pneumonia. In the literature only ten cases have been reported. We report two cases of minocycline which induced (eosinophilic) alveolitis. A high fever, dry cough, dyspnoea and fatigue are the main features of the clinical picture. Peripheral blood eosinophilia and elevated total IgE content were seen in one patient. Bronchoalveolar lavage in this patient revealed eosinophilia. Transbronchial lung biopsies showed infiltration with eosinophilic granulocytes in both patients. Airway macrophages contained brown-black pigment granules. In the acute stage an important decrease in diffusion capacity was observed. The pulmonary and systemic symptoms promptly cleared up after discontinuation of minocycline. Provocation with minocycline was positive, because both patients noticed the same symptoms within one day.

Topics: Adult; Bronchoalveolar Lavage Fluid; Drug Hypersensitivity; Humans; Male; Middle Aged; Minocycline; Pulmonary Eosinophilia; Rosacea

Topics: Aged; Eosinophils; Humans; Leukocyte Count; Male; Minocycline; Pulmonary Eosinophilia

Topics: Female; Humans; Middle Aged; Minocycline; Pulmonary Eosinophilia; Skin Diseases, Infectious; Tetracyclines

Topics: Acne Vulgaris; Administration, Oral; Adult; Carbon Dioxide; Female; Humans; Male; Minocycline; Oxygen; Pulmonary Eosinophilia; Radiography; Tetracycline; Tetracyclines; Urinary Tract Infections