Minocycline-induced vasculitis

Excerpt

A 35-year-old woman was admitted to our hospital with a 3-month history of fever and polyarthralgia. She was being treated with minocycline for the past 1 year due to acne vulgaris. On physical examination, she had patchy erythema and a nonpruritic eruption on both lower extremities (Fig. 1a). There were no neurological manifestations. Her C-reactive protein level was 2.6 mg/dL. Immunological survey showed positive perinuclear antineutrophil cytoplasmic antibody (p-ANCA) and antinuclear antibody (1:160; homogeneous pattern). All other antibody titers, including myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA), proteinase 3-anti-neutrophil cytoplasmic antibody, rheumatoid factor, hepatitis B surface antigen, and hepatitis C virus antibody, were negative. The urinalysis and contrast-enhanced CT were normal. Histological examination of the biopsy specimens from the livedo reticularis showed necrotizing vasculitis of medium-sized arteries in the deep dermis, consistent with the diagnosis of polyarteritis nodosa (PAN) (Fig. 1b, c). In the setting of minocycline use, the combination of systemic symptoms suggests the diagnosis of ANCA associated vasculitis. The symptoms, including fever, cutaneous lesions, and arthralgias, improved rapidly after minocycline discontinuation and disappeared within a few days. Since then, she has been no immunosuppressive drugs for 12 months without recurrence, but p-ANCA still remains positive.

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