Vasculitic neuropathy following exposure to minocycline

Abstract

Objective:To report 3 patients with minocycline-induced autoimmunity resulting in peripheral nerve vasculitis.Methods:We report 3 patients who, during minocycline treatment for acne vulgaris, developed subacute onset of pain and weakness caused by vasculitis in single and multiple mononeuropathy patterns.Results:Each patient underwent either a nerve or muscle biopsy that confirmed vasculitis. One patient additionally developed systemic symptoms (including fever, fatigue, and night sweats) and another had a posterior circulation stroke. Symptoms developed with either early or prolonged use of minocycline. Despite withdrawal of minocycline, patients needed long-term immunotherapy to gain neurologic improvement.Conclusions:Our findings suggest that the typical neuropathy associated with minocycline use is painful single or multiple mononeuropathy due to peripheral nerve vasculitis, which may also be accompanied by presumed CNS vasculitis (presenting as stroke).

Mononeuritis multiplex associated with minocycline in an adolescent

“…Test results of all autoantibodies were subsequently negative with the exception of ANA, which remained positive when retested 2 years later . A 17‐year‐old adolescent girl developed mononeuritis multiplex after 3 years of minocycline use . She was reported to show clinical improvement with discontinuation of minocycline and treatment with corticosteroids and azathioprine .…”

“…Minocycline is a synthetic tetracycline‐derived antibiotic often used to treat acne. It has been associated with several autoimmune disorders: drug‐induced lupus, polyarteritis nodosa, autoimmune hepatitis, serum sickness‐like reaction, and vasculitic neuropathy . We report the case of a adolescent boy who developed a painful right peroneal neuropathy, followed by a distal left sciatic neuropathy.…”

Vasculitic Neuropathies

“…Several cases of vasculitic neuropathy have been reported, some consistent with drug-induced lupus 79 or PAN, 80 and others without signs of other autoimmune conditions. 79,81,82 The presentation is typically multiple mononeuropathies. The length of exposure to minocycline varies and can be as short as 2 weeks or as long as 4 years.…”

“…The length of exposure to minocycline varies and can be as short as 2 weeks or as long as 4 years. 81,82 Treatment consists of discontinuation of the drug and administration of corticosteroids or additional immunosuppressive agents. Anti-programmed death 1 (PD-1) antibodies, such as pembrolizumab and nivolumab, function as immune checkpoint inhibitors and are increasingly being used for treatment of both solid-organ and hematological malignancies.…”

An interesting variety

“…Minocycline is a synthetic tetracycline and its use may result in autoimmune disorders such as drug-induced lupus, polyarteritis nodosa–like syndrome, autoimmune hepatitis, or vasculitic neuropathy. Baratta et al 6 report 3 patients who developed pain and weakness in the distribution of single or multiple individual nerves, with evidence of ischemic injury and vasculitis on nerve and muscle biopsy, following minocycline treatment for acne vulgaris. One of the patients, a 17-year-old woman, developed in addition to peripheral nerve involvement an acute right medial medullary ischemic stroke.…”