Minocycline-induced black bone disease of the skull

Excerpt

A 27-year-old woman presented to the neurosurgery clinic with a two-month history of serous discharge in the right temporal region. Five years earlier, she had undergone emergency craniotomy for subcortical intracerebral hemorrhage, followed by cranioplasty. The skull bone had exhibited a normal coloration at the time of the initial craniotomy. Four months after the initial craniotomy, she developed surgical site infection and had since been prescribed minocycline for long-term suppression at another hospital. On physical examination, wound leakage was observed. Surgical debridement was performed for suspected recurrence of surgical site infection. Intraoperatively, black discoloration was noted on both the surface of the bone flap and the remaining skull bone (Figs. 1 and 2). No skin or tooth pigmentation was observed. Histopathological examination showed no finding of bone necrosis or osteomyelitis, and bone culture yielded no growth. A diagnosis of minocycline-induced bone hyperpigmentation was made, and minocycline was discontinued. No signs of infection have since been observed. …