minocycline and Vasculitis

Vasculitic neuropathies usually present acutely to subacutely, with an asymmetric pattern, involving multiple peripheral nerve territories. Drug-induced vasculitis is an often overlooked etiology of vasculitic neuropathy.. We present the first reported case of nitrofurantoin-associated and an illustrative case of minocycline-associated vasculitic neuropathy, with a review of the literature.. The first patient is a 60-year-old woman who developed axonal sensorimotor peripheral neuropathy after nitrofurantoin use, with a superficial radial nerve biopsy confirming vasculitis. The second patient is a 23-year-old woman, with a history of acne vulgaris treated with minocycline, who presented with a subacute right common peroneal mononeuropathy followed by a left deep peroneal mononeuropathy, with elevated antinuclear, perinuclear-antineutrophil cytoplasmic, and myleoperoxidase antibodies, and MPO titers, and a sural nerve biopsy showing large arteriole vasculitis. Finally, we provide a comprehensive review of previously published cases.. Medications should be considered as a trigger for medication-induced vasculitic neuropathy. Accurate diagnosis would ensure timely treatment.

Topics: Adult; Female; Humans; Middle Aged; Minocycline; Nitrofurantoin; Peripheral Nervous System Diseases; Peroneal Neuropathies; Vasculitis; Young Adult

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

Case reports have suggested that minocycline, sulfasalazine, and penicillamine are associated with antineutrophil cytoplasmic antibody (ANCA)-positive vasculitis. This study evaluated ANCA seroconversion due to these agents in serum samples prospectively collected in randomized, double-blind, controlled trials.. The sources of study sera were 3 clinical trials: 1) a 48-week trial of minocycline for early rheumatoid arthritis, with 64 patients receiving minocycline compared with 68 receiving placebo; 2) a 37-week trial of sulfasalazine for rheumatoid arthritis, with 51 receiving sulfasalazine compared with 38 receiving placebo; and 3) a 104-week trial of penicillamine for early systemic sclerosis, with 15 undergoing high-dose penicillamine treatment versus 12 receiving low-dose penicillamine. ANCA were measured in the baseline and study-end serum samples by indirect immunofluorescence (IIF) for perinuclear ANCA (pANCA) and cytoplasmic ANCA (cANCA) patterns, and by antigen-specific enzyme-linked immunosorbent assay (ELISA) for antibodies to myeloperoxidase (anti-MPO) and proteinase 3 (anti-PR3). Laboratory personnel were blinded to the group identity of the samples. ANCA results were interpreted using an ANCA scoring system that combines the results of IIF and ELISA testing.. No patient in any of the active study drug groups demonstrated ANCA seroconversion according to the final interpretation of the combined IIF and ELISA results. Twelve of the 248 patients (5%) were positive for anti-MPO with pANCA at baseline. No subject was positive for anti-PR3 with cANCA. There were no findings suggestive of vasculitis in any of these patients.. From our study results, there was no suggestion of ANCA seroconversion induced by minocycline, sulfasalazine, or penicillamine. However, these findings do not rule out the possibility of rare, sporadic cases of either ANCA seroconversion or true drug-induced vasculitis with these drugs.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Antibodies, Antineutrophil Cytoplasmic; Double-Blind Method; Humans; Minocycline; Penicillamine; Sulfasalazine; Vasculitis

Propionibacterium acnes (P. acnes) is a commensal bacterium indigenous to the skin. Previous reports have suggested that infection with P. acnes causes sarcoidosis, a systemic granulomatous disease. We present the case of a 63-year-old woman who developed subcutaneous nodules. A skin biopsy revealed necrotizing vasculitis and noncaseating granulomas, which are characteristic of sarcoidosis. Immunohistostaining revealed a P. acnes skin infection, which led to the diagnosis of sarcoidosis. Minocycline treatment resolved the infection and improved the patient's symptoms. We herein report a case in which immunohistochemistry was useful in the diagnosis of sarcoidosis.

Topics: Anti-Bacterial Agents; Antibodies, Monoclonal; Biopsy; Female; Granuloma; Humans; Immunohistochemistry; Japan; Middle Aged; Minocycline; Propionibacterium acnes; Sarcoidosis; Treatment Outcome; Vasculitis

We report an original case of reversible antiphospholipid syndrome (APS) due to minocycline in a young male patient who experienced recurrent strokes while taking minocycline. He started minocycline therapy (50 mg twice daily) at 15 years old for acne. After three years of treatment, the patient experienced a lateral medullary syndrome. He was treated with aspirin while minocycline was continued. Eighteen months later, the patient complained about horizontal binocular diplopia. MRI revealed an infarct of the oculomotor nerve nucleus. Laboratory investigations revealed high titers of anti-beta 2 glycoprotein 1 (antiβ2GP1) antibodies of 470 U/ml (normal range <15 U/ml) and antiphosphatidylethanolamine antibodies of 137.4 U/ml (normal range <18 U/ml). Other laboratory tests were normal. Six weeks after discontinuation of minocycline, anti-β2GP1 antibodies decreased to 335 U/ml and to 36 U/ml at six months and then remained negative for six years. Many drugs have been considered as possibly causing APS but only in a limited number of patients. To our knowledge this is the first case of drug-induced APS with complete disappearance of high titers of anti-β2GP1 antibodies after minocycline withdrawal. This case also illustrates the need to monitor the levels of antiphospholipid antibodies, even though initial values are high and confirmed after 12 weeks.

Topics: Anti-Bacterial Agents; Antibodies, Antiphospholipid; Antiphospholipid Syndrome; beta 2-Glycoprotein I; Humans; Lateral Medullary Syndrome; Magnetic Resonance Imaging; Male; Minocycline; Stroke; Treatment Outcome; Vasculitis; Young Adult

We describe 2 patients presenting with multiplex mononeuritis, associated with skin manifestation, secondary to minocycline-induced vasculitis. One of the cases is associated neither with lupus nor polyarteritis nodosa. An extensive laboratory workup ruled out any possible underlying immunologic disorder. Electrodiagnostic studies were conducted to show axonal neuropathy in patchy and multifocal distribution consistent with multiplex mononeuritis. This diagnosis was confirmed with nerve biopsy. Withdrawing from the offending medication, minocycline, improved the patients' clinical condition and the quantitative serological measures.

Topics: Adult; Anti-Bacterial Agents; Anti-Inflammatory Agents; Biopsy; Female; Humans; Male; Middle Aged; Minocycline; Mononeuropathies; Muscle, Skeletal; Neural Conduction; Peripheral Nerves; Prednisone; Vasculitis

Topics: Acne Vulgaris; Adolescent; Diagnosis, Differential; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug-Related Side Effects and Adverse Reactions; Female; Fever; Humans; Magnetic Resonance Imaging; Minocycline; Positron-Emission Tomography; Risk Factors; Sweating; Vasculitis; Weight Loss; Withholding Treatment

Topics: Adolescent; Humans; Knee; Male; Minocycline; Mononeuropathies; Prednisone; Vasculitis

Bordetella bronchiseptica is a bacterial pathogen usually isolated from animals and rarely causes human infections. There are, however, some reports that B. bronchiseptica causes human respiratory infections in immunocompromised patients or those with underlying respiratory diseases, although there is a lack of treatment guidelines. An 80-year-old woman was admitted to our hospital to treat anti-neutrophil cytoplasmic antibodies-associated vasculitis. On the 16th day after admission, she complained of a productive cough with right pleuritic pain and had low-grade fever. After chest CT scans, we diagnosed pneumonia. Gram stain of her sputum revealed moderate levels of gram-negative coccobacilli, which was later identified as B. bronchiseptica by mass spectrometry. According to the result of minimum inhibitory concentration, we successfully treated the pneumonia with minocycline. This case suggests that B. bronchiseptica pneumonia can be treated by minocycline if the minimum inhibitory concentration is less than 0.25 μg/mL.

Topics: Aged, 80 and over; Antibodies, Antineutrophil Cytoplasmic; Bordetella bronchiseptica; Bordetella Infections; Female; Humans; Minocycline; Pneumonia; Respiratory Tract Infections; Vasculitis

Segmental testicular infarction is an uncommon clinical entity marked by acute scrotal pain and swelling. Classically, these appear as wedge-shaped, avascular, hypoechoic lesions on a testicular ultrasound. We present a unique case of testicular infarct caused by an antineutrophil cytoplasmic antibody-positive vasculitis secondary to the use of the antibiotic minocycline. The patient's symptoms resolved with cessation of minocycline. We suggest that patients who present with otherwise unexplained testicular infarction undergo a careful review of medications to uncover a potential cause.

Topics: Adolescent; Anti-Bacterial Agents; Antibodies, Antineutrophil Cytoplasmic; Humans; Infarction; Male; Minocycline; Testis; Vasculitis

Minocycline is an antibiotic used for the treatment of acne. It has been associated with several autoimmune syndromes, including drug-induced lupus, autoimmune hepatitis, and vasculitis.. We report a case of a 28-year-old previously healthy woman who developed a left sciatic mononeuropathy 2 weeks after starting minocycline for acne. Magnetic resonance imaging studies supported the localization. A biopsy of the left sural nerve revealed acute nerve large arteriole necrotizing vasculitis. Her condition improved after the withdrawal of minocycline and a course of treatment with methylprednisolone.. This case provides further evidence that minocycline may induce a nonsystemic necrotizing vasculitis.

Topics: Adult; Anti-Bacterial Agents; Female; Humans; Minocycline; Mononeuropathies; Sciatic Neuropathy; Treatment Outcome; Vasculitis

A 70-year-old woman was admitted to our hospital because of fever, numbness in her extremities and right drop foot. Because her hip prosthesis had loosened as a result of infection, she had been taking 100 mg of minocycline orally for eight months. Three months before admission, she had had melena several times and body weight loss and pyrexia developed. A month before admission, asymmetrical paresthesia and numbness appeared in her extremities and finally right drop foot developed. Laboratory tests showed elevated C-reactive protein and positive anti-nuclear antibody. Abnormalities found in nerve conduction study were compatible with mononeuritis multiplex. Sural nerve biopsy revealed an occluded medium-size artery in the epineurium and axonal degeneration in the nerve fascicles, confirming the diagnosis of vasculitic neuropathy. These manifestations met the American Congress Rheumatology criteria for polyarteritis nodosa. However, her clinical conditions markedly improved after discontinuing minocycline and therefore she was diagnosed as having minocycline-induced vasculitic neuropathy. Although minocycline-induced vasculitis is a well known adverse effect of the drug, peripheral neuropathy with biopsy findings has rarely been reported. Drug induced-vasculitis is important as a differential diagnosis for mononeuritis multiplex because the symptoms can be improved by the discontinuation of an offending drug.

Topics: Aged; Anti-Bacterial Agents; Antibodies, Antinuclear; Biomarkers; C-Reactive Protein; Diagnosis, Differential; Female; Hip Prosthesis; Humans; Minocycline; Mononeuropathies; Neural Conduction; Peripheral Nervous System Diseases; Prosthesis-Related Infections; Sural Nerve; Vasculitis

Topics: Adult; Anti-Bacterial Agents; Drug Eruptions; Humans; Hyperpigmentation; Leg Dermatoses; Male; Minocycline; Vasculitis

We report a patient with lepromatous leprosy who developed a rare variant of type-2 lepra reaction, characterized by pustular lesions, on switching from WHO multi drug therapy (MDT) to ofloxacin-aided MDT.

Topics: Abscess; Adult; Drug Resistance, Bacterial; Drug Therapy, Combination; Erythema Nodosum; Humans; Leprostatic Agents; Leprosy, Lepromatous; Macrophages; Male; Melanins; Minocycline; Mycobacterium tuberculosis; Neutrophils; Ofloxacin; Rifampin; Tumor Necrosis Factor-alpha; Vasculitis

Neutrophilic dermatosis (pustular vasculitis) of the dorsal hands is a recently described disorder, which may clinically resemble a localized variant of Sweet syndrome.. To describe the clinical and histopathologic characteristics of this rare disorder; to compare and contrast these features with those of Sweet syndrome; and to investigate possible associations with systemic diseases.. Seven women were referred for pustular or ulcerative plaques and nodules on the dorsal hands. In most patients, the initial diagnosis was cutaneous infection, but antibiotic therapy was ineffective. Skin biopsy specimens showed dense dermal neutrophilic infiltrates with leukocytoclasis and fibrinoid vascular necrosis. Cutaneous cultures yielded negative findings in all cases. Prednisone and dapsone appeared to be helpful, but recurrences were common. Minocycline hydrochloride was of uncertain benefit. Among the 7 patients, possible systemic associations included bowel disorders and a urinary tract infection.. Neutrophilic dermatosis of the dorsal hands may be closely related to Sweet syndrome but frequently shows the histologic pattern of leukocytoclastic vasculitis. Recognition of this disorder is important, because it may be misdiagnosed as a localized cutaneous infection. Additional studies are needed to investigate further the possible associations with internal diseases, especially bowel disorders.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Dapsone; Female; Glucocorticoids; Hand Dermatoses; Humans; Middle Aged; Minocycline; Neutrophils; Prednisone; Recurrence; Suppuration; Treatment Outcome; Vasculitis

In recent years, minocycline has become a commonly used agent for the treatment of acne vulgaris and rosacea. With this increased use have come reports of severe and in some cases life-threatening toxicity, often occurring in otherwise healthy young women after prolonged courses of minocycline. These adverse reactions include hepatotoxicity, drug-induced lupus erythematosus, eosinophilic pneumonitis, and hypersensitivity syndrome. We describe a 35-year-old woman who had necrotizing vasculitis of the skin and uterine cervix after 2 years of minocycline therapy for acne vulgaris. Skin and cervical biopsies revealed acute inflammation involving through-and-through necrosis of vessel walls with thrombosis, focal fibrinoid change, and a perivascular lymphohistiocytic infiltrate. The disease fully resolved within 3 months of discontinuance of the minocycline therapy. Patients should be informed of these rare but potentially serious adverse effects before the initiation of minocycline therapy. Early recognition of these complications can result in complete resolution.

Topics: Acne Vulgaris; Adult; Anti-Bacterial Agents; Drug Eruptions; Female; Humans; Minocycline; Uterine Cervical Diseases; Vasculitis