Minocycline antinuclear antibody

Immunoallergic reactions have been reported with minocycline and include lupus-like syndrome, autoimmune hepatitis, eosinophilic pneumonia, hypersensitivity syndrome, a serum sickness-like illness (29), and Sweet s syndrome (SEDA-21, 262) (SEDA-22, 271). Over 60 minocycline-induced cases of lupus-like syndrome and 24 cases of minocycline-induced autoimmune hepatitis were found in a review of the literature (30). In 13 patients, both disorders co-existed. These patients had symmetrical polyarthralgia/polyarthritis, raised liver enzymes, and positive antinuclear antibodies they were also generally antihistone-negative, and only two patients had p-ANCA antibodies. Minocycline-related lupus can also occur in adolescents (31). 

Minocycline-induced lupus usually occurs some months, or even years, after the start of therapy, and it usually resolves when the drug is withdrawn. The diagnosis can easily be overlooked, especially in patients with rheumatoid arthritis (37). It would always be wise to foUow the recommendation that a patient s antinuclear antibody be checked before starting minocycline and when drug-induced lupus is suspected. 

According to the authors, the patient fulfilled all the criteria for a diagnosis of drug-induced lupus-like syndrome, that is no history of lupus erythematosus before minocycline therapy, the presence of antinuclear antibodies, at least one clinical feature of lupus erythematosus, and prompt recovery after withdrawal of minocycline. She also had positive antihistone antibodies, compatible with drug-induced lupus-like syndrome. 

Seven patients (17-22 years old) developed sjmptoms of arthralgia and arthritis after having taken minocycline 50-100 mg bd for 6-36 months for acne vulgaris (47). Increased titers of perinuclear ANCA were detected in all seven, five had fluorescent antinuclear antibodies, two had antihistone autoantibodies, and one had anticardiohpin antibodies. Symptoms resolved in five patients on withdrawal the other two were treated with corticosteroids and also achieved remissions. 

Three adolescents taking therapeutic doses of minocycline for 12-20 months met the 1993 International Autoimmune Hepatitis Group criteria for autoimmune hepatitis. All had hypogammaglobulinemia and positive antinuclear antibody and antismooth muscle antibody titers. Two underwent liver biopsy that showed severe chronic lymphoplasmocytic inflammation, necrosis, and fibrosis. All other causes of liver disease were excluded. One patient had resolution of symptoms after withdrawal of the drug, while two required immunosuppressive therapy. 

A 70-year-old woman developed a fever, asymmetrical paresthesia, numbness in her limbs, and right foot drop after taking oral minocycline lOOmg/day for 8 months. There was a positive antinuclear antibody, and a nerve conduction study showed abnormahties... 

Minocycline-induced hepatitis with antinuclear, anti-mitochondrial, and antismooth muscle antibodies has been reported in a 19-year-old black West Indian woman who had been treated for acne for two years with oral minocycline (50 mg/day) and topical benzoyl peroxide (5%) (46). 

---