Minocycline-induced renal polyarteritis nodosa

Abstract

SummaryMinocycline is a bacteriostatic, long-acting, lipid-soluble tetracycline that is generally well tolerated, but has been associated with polyarteritis nodosa (PAN). This is a case report of a 21-year-old woman presented to her primary care physician with several months of fatigue, mylagias, weight loss and intermittent severe bi-temporal headaches without changes in vision. Her medications included an Ortho-Tri-Cyclen Lo and Minocycline, which she started 2 years prior for acne. On presentation, she was tachycardic and severely hypertensive. Initial laboratory evaluation showed hyponatraemia and hypokalaemia as well as elevation of inflammatory markers. Autoimmune work-up was positive for perinuclear antineutrophil cytoplasmic antibodies. Renal arteriogram was characteristic of PAN and along with her other symptoms, she fulfilled the necessary criteria of American College of Rheumatology for diagnosis of PAN. Minocycline as a possible causative agent was discontinued since it was reported to cause cutaneous PAN in the literature. Cyclophosphamide and prednisone were initiated for treatment of her vasulculitis. Her symptoms and hypertension improved over the next several months. This is the first report of the minocycline-induced renal PAN. BACKGROUND

A Case of Diffuse Alveolar Hemorrhage Associated with High-Titer of MPO-ANCA Demonstrating Cytoplasmic Staining Pattern

“…However, we reason that minocycline was likely not the precipitating factor of her vasculitis. With regard to the clinical manifestations of vasculitis, minocycline is most commonly associated with arthritis, livedo reticularis, and polyarteritis nodosa-(PAN-) like medium vessel vasculitis [12][13][14][15][16][17][18][19]. As is the case in PAN per se, pulmonary involvement appears to be uncommon in minocycline-induced vasculitis [14,16,17,20].…”

“…With regard to the clinical manifestations of vasculitis, minocycline is most commonly associated with arthritis, livedo reticularis, and polyarteritis nodosa-(PAN-) like medium vessel vasculitis [12][13][14][15][16][17][18][19]. As is the case in PAN per se, pulmonary involvement appears to be uncommon in minocycline-induced vasculitis [14,16,17,20]. A case of minocyclineinduced pauci-immune crescentic glomerulonephritis was reported; however, the argument for causality was Case Reports in Rheumatology 3 dampened by that the patient had been treated with a pulse dose of steroid, plasmapheresis, and cyclophosphamide [21].…”

Remission of Angiographically Confirmed Minocycline-induced Renal Polyarteritis Nodosa: A Case Report and Literature Review

“…Although most PAN cases are idiopathic, there are reports of secondary PAN associated with viral infections, malignancies, and medications (6). Minocycline, a semisynthetic tetracycline derivative that is widely used for acne vulgaris, has been associated with the development of secondary PAN (6)(7)(8)(9)(10)(11)(12)(13)(14). However, due to its relatively low incidence and prevalence, the clinical course and treatment of minocycline-induced PAN are not fully understood.…”