[Systemic reaction induced my minocycline treatment: a report of four patients and a review of the literature]

Drug Hypersensitivity Syndrome Caused by Minocycline

Background:

Minocycline is a commonly prescribed drug for the treatment of acne. Its use is generally not associated with systemic side effects.

Objective:

To describe a case of minocycline-induced drug hypersensitivity syndrome in a 20-year-old Japanese woman.

Methods and Results:

Following 2 months of minocycline treatment, the patient developed skin lesions composed of exudative maculopapules, purpuratous macules, and target-like, erythema multiforme-like plaques over most of her body. In addition, she had fever, abnormal liver function tests, eosinophilia, and atypical lymphocytosis. Laboratory tests indicated no elevation of antibody titers against cytomegalovirus, Epstein-Barr virus, and human herpesvirus 6. Her ongoing exposure to minocycline was stopped, and treatment with oral prednisolone was begun. Her signs, symptoms, and laboratory abnormalities then began to resolve. Subsequently, the syndrome was observed to return briefly in response to an oral challenge with minocycline.

Conclusions:

Minocycline is able to elicit a drug hypersensitivity syndrome that can resemble infectious mononucleosis. This drug reaction can be treated effectively by cessation of exposure to this drug and steroid therapy.

Minocycline in acne vulgaris: benefits and risks

Minocycline is a semi-synthetic, second-generation tetracycline. It was introduced in 1972 and has both antibacterial and anti-inflammatory properties. Minocycline is used for a variety of infectious diseases and in acne. Even today, new indications beyond the antibacterial indications are being investigated such as its use in neurologic diseases. Formerly, minocycline was thought to have a superior efficacy in the treatment of inflammatory acne, especially with respect to antibacterial-resistant Propionibacterium acnes. A thorough review of the literature, however, shows that minocycline is not more effective in acne than other tetracyclines. Compared with first-generation tetracyclines, minocycline has a better pharmacokinetic profile, and compared with doxycycline it is not phototoxic. However, minocycline has an increased risk of severe adverse effects compared with other tetracyclines. It may induce hypersensitivity reactions affecting the liver, lung, kidneys, or multiple organs (Drug Reaction with Eosinophilia and Systemic Symptoms [DRESS] syndrome) in the first weeks of treatment and, with long-term treatment, may cause autoimmune reactions (systemic lupus erythematosus, autoimmune hepatitis). In addition, CNS symptoms, such as dizziness, are more frequent compared with other tetracyclines. Long-term treatment may induce hyperpigmentation of the skin or other organs. Resistance of P. acnes to minocycline also occurs, dependent on the prescribing behavior. Considering the aspects of efficacy, its adverse effect profile, resistance, price, and alternatives, minocycline is no longer considered the first-line antibacterial in the treatment of acne.

Causes non parasitaires des grandes hyperéosinophilies

Diagnosis of major hypereosinophilia (>1500 x 10(9)/L) is complex because the possible causes cover the entire range of medical specialties. History and clinical condition will usually suggest parasitic or allergic diseases or drug reactions. When workups for them are negative, rarer causes must be suspected: specific organ diseases (chronic eosinophilic pneumonia, bullous pemphigoid, etc.), solid tumor, clonal blood disorders, or vasculitis. When the condition is prolonged and unexplained, hypereosinophilic syndrome is diagnosed. A rare disorder, its prognosis depends on largely on its cardiac effects. It is usually associated with heterogeneous hematologic conditions, mainly myeloproliferative and lymphocytic disease. The myeloproliferative or primary variant sometimes follows chromosomal deletions that cause a fusion between the Fip1-like1 (FIP1L1) and platelet-derived growth factor receptor (PDGFR) genes, thus increasing the tyrosine kinase activity of the latter. Imatinib mesylate, a tyrosine kinase inhibitor, is usually effective in this situation. In the lymphocytic variant, hypereosinophilia is secondary to a primitive Th2 lymphocyte expansion that causes overproduction of interleukin 5 (IL-5). Corticosteroids are the first-line therapy. Mepolizumab, an anti-IL-5 monoclonal antibody, currently being evaluated, seems promising. Despite recent progress, about 40% of the cases of hypereosinophilic syndrome remain unexplained.

[Cyclines and acne: pay attention to adverse drug reactions! A recent literature review]

PURPOSE

Cyclines are broad-spectrum antibiotics often used in acne. Side effects might occur precociously or more insidiously during long term treatment such in acne. The aim of this study is to review all adverse effects recently reported in this indication.

CURRENT KNOWLEDGE AND KEY POINTS

A literature review from 1997 to 2001 has been conducted. Seventy-six articles reporting 250 cases have been found. Data analysis indicated that minocycline is the most widely incriminated molecule. Seventy-two cases revealed autoimmune disorders : lupus like syndrome associated or not with autoimmune hepatitis, 5 cases developed vasculitis. These reactions occurred in long term treatment (several weeks to several months). Fifteen cases of hypersensitivity syndromes and 3 cases of serum sickness like illness have been reported. These reactions occurred within the first weeks of exposure. Twenty-four cases of pseudotumor cerebri and 123 cases of abnormal pigmentations (skin, nails, mouth, bones or organs) have also been found. Eight cases presented other diseases.

FUTURE PROSPECTS AND PROJECTS

Adverse effects of cyclines might be serious and sometimes unknown. Long term treatment by tetracyclines must be researched in patients presenting such symptoms. Moreover, several adverse drug reactions might be avoided by an optimal use of the drug (oesophageal ulcerations, photosensitivity) or by shorter periods of treatment (autoimmune disorders, pigmentations); only DRESS are drug adverse reactions unpredictable and sometimes severe.

Drug induced pericarditis in a patient with chronic renal failure

Drug induced pericarditis is reported very rarely. We presented a patient with pericarditis due to antituberculosis therapy induced pericarditis and chronic renal failure. We did not find clinical and serologic findings of pseudo-lupus clinical symptoms and pericarditis regressed in a short time with cessation of antituberculosis drugs and initiated steroid.