Minocycline-induced Lupus in Adolescents

Abstract

9. Golstein PE, Deviere J, Cremer M. Acute hepatitis and drug-related lupus induced by minocycline treatment. Am J Gastroenterol. 1997;92:143-146. 10. Singer SJ, Piazza-Hepp TD, Girardi LS, Moledina NR. Lupuslike reaction associated with minocycline. JAMA. 1997;277:295-296. 11. Crosson J, Stillman MT. Minocycline-related lupus erythematosus with associated liver disease. J Am Acad Dermatol. 1997;36(5 More than 44000 new cases of melanoma are detected annually in the United States, and the number is steadily increasing. The majority of patients are treated with surgical excision and may, in addition, undergo sentinel node mapping, lymph node dissection, and adjunctive treatment. The purpose of this study was to develop rational, evidence-based guidelines for following up patients with 1983 American Joint Committee on Cancer stage I (Ͻ1.5 mm thick), II (localized disease Ͼ1.5 mm thick), and III (local nodal or in-transit metastases) melanoma. The study was a retrospective review of charts of 373 patients who were followed up according to the surveillance protocol at the Yale Melanoma Unit, New Haven, Conn, between January 1988 and December 1994. Each patient was followed up for at least 2 years. The surveillance protocol included combined frequent comprehensive examination with extensive patient education. Periodic examinations included history and physical examination; laboratory tests, such as complete blood cell count, liver function tests , and serum lactate dehydrogenase level; and chest x-ray (CXR) (computed tomographic scans were done for patients with stage III melanoma).The collected data included (1) the time between first visit and recurrence; (2) whether the recurrence was detected by the patient or by a physician during a follow-up visit; (3) the method of detection for physician-detected recurrences (ie, history and physical examination, review of systems, complete blood cell count, liver function tests, serum lactate dehydrogenase level, and CXR or other imaging techniques); (4) survival; (5) location of recurrences; and (6) development of second primary melanomas.The results indicated that there were recurrences in 52 (25%) of 210 males and 26 (16%) of 163 females. Of the 373 patients, 78 (21%) had a recurrence. The proportions of patients who developed recurrence were 9 (5%) of 193, 35 (30%) of 117, and 34 (54%) of 63, for patients with stage I, II, and III disease, respectively. The median time to recurrence in patients with stages I, II, and III disease was 22 months (range, 2-61 months), 13 months (range, 2-71 months), and 11 months (range, 2-54 months), respectively. Most patients (n=62, 79%) who developed a recurrence in the follow-up period did so within the first 2 years. Six percent (n=5) of patients developed recur-(REPRINTED) ARCH DERMATOL / VOL 136, SEP 2000

Minocycline-Related Autoimmune Hepatitis

“…Initial studies emphasized its relative safety and identified common adverse effects including headache, lightheadedness, vertigo, nausea, weakness, and rash. [1][2][3] As its use has increased, more serious sequelae have been identified, including serum sickness-like reaction, drug-induced lupus, 4 pneumonitis, hypersensitivity syndrome reaction, acute febrile neutrophilic dermatosis (Sweet disease), and hepatitis. 5 We describe 3 adolescents in whom autoimmune hepatitis developed related to minocycline use.…”

“…Others who responded to withdrawal of the drug alone may be reacting to an antigen that bears similarity to an autoantigen. Whether the minocycline is responsible for the autoimmune hepatitis in this large population of adolescents exposed to the drug is difficult to determine; causation is supported by the number of reports linking the two, 5,6,[8][9][10][11][12] the association of minocycline with other autoimmune diseases like lupus, 4,5,12 and the resolution of symptoms in the majority of affected patients when the drug is withdrawn.…”

Minocycline-Induced Lupus in Adolescents: Clinical Implications for Physical Therapists

“…Clinical symptoms are similar to those of SLE in that arthralgia, arthritis, myalgia, fever, and malaise are often present. 1,23,34,41,[45][46][47] Drug-induced lupus differs from SLE in that there is less of a discrepancy in the male-female ratio, skin involvement is dependent on the specific medication in DIL but is generally less common than in SLE, and renal involvement is comparatively less frequent in DIL than in SLE. 41 Testing positive for ANAs is a common finding in SLE and in DIL.…”

“…However, testing positive for antibodies to doublestranded DNA is common in SLE but is rare in DIL. 1,34,41 In SLE, the ANAs and the antibodies to double-stranded DNA are theorized to bond with their common antigen, resulting in immune complexes that are deposited in the skin (in the case of discoid lupus erythematosus) or in vascular tissues throughout the body t study desiGn: Resident's case problem. t bAckGRound: In the United States, minocycline is a frequently prescribed medication for the treatment of moderate to severe acne, a common condition in adolescents.…”

“…23,34,41,47 Despite the mechanism, once the offending medication is discontinued, the effects of DIL typically begin to resolve immediately and completely resolve within a few weeks to months. 1,24,34,41 Since the initial description of DIL, as many as 70 medications have been linked to DIL, accounting for up to 10% of the cases of lupus annually in the United States. 41,44 41 Other commonly prescribed medications such as angiotensin-converting enzyme inhibitors and statins are suspected of having a link with DIL, but significant evidence to support these suspicions is lacking to date.…”