Lupus-like syndrome minocycline

Minocycline is associated with a relatively high incidence of hepatotoxicity. In many cases it is quite distinct from minocycline-induced lupus, occurs earlier in the course of treatment (about 1 month), and the mechanism is unknown [62], However, in some cases the liver toxicity merges with the lupus-like syndrome, occurring after about a year of therapy, and is associated with ANA. This form is indistinguishable from idiopathic autoimmune hepatitis [63], and antibodies against Cyp 3A6 and Cyp 2C4 have been reported [64], Diclofenac has also been reported to cause hepatitis with autoimmune features such as ANA [65],... 

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). 

In a retrospective review of drug safety databases, minocychne was the only tetracychne derivative that caused drug-induced lupus (SEDA-22, 268) (38). The authors proposed that the propensity of minocycline to cause drug-induced lupus may be due to the presence of a functional group that is easily oxidized to a reactive metabolite. However, the chemicaUy modified tetracycline CMT-3, which has also reportedly caused a lupus-like syndrome (39), lacks this group, so another theory is needed. 

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. 

Graham LE, Bell AL. Minocycline-associated lupus-like syndrome with ulnar neuropathy and antiphospholipid antibody. Clin Rheumatol 2001 20(l) 67-9. 

In a matched nested case-control study using data from the UK General Practice Research Database (GPRD) there were 875 cases of a lupus-like syndrome, of which 12% ( = 107) had evidence of a prescription for one or more of the suspected drugs, and they were compared with 3632 matched controls [68 ]. There was an increased risk of lupus-like syndrome with hydralazine (OR = 6.6, 95% CI = 1.03, 43), minocycline (OR = 4.2, 95% Cl = 2.7, 6.8) and carbamazepine (OR = 1.9, 95%... 

A lupus-like syndrome with neutropeiua has been associated with minocycline in an 18-year-old man [145 ]. 

Gough, A. et al., Minocycline induced autoimmune hepatitis and systemic lupus erythe-matosus-like syndrome, Br. Med. J., 312, 169, 1996. 

Certain drugs, such as hydralazine, procainamide, isoniazid, chlorpromazine, and minocycline, can provoke lupus-like manifestations (D Cruz, 2000). Clear differences between systemic lupus erythematosus and lupus syndrome can be identified — hence the recommended different terminology. Typical clinical features of the drug-induced lupus syndrome include arthralgias, arthritis, rash, and... 

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