Tetracycline-, Doxycycline-, Minocycline-Induced Pseudotumor Cerebri and Esophageal Perforation

Angelette, Alexis; Rando, Lauren; Wadhwa, Reena D; Barras, Ashley A; Delacroix, Blake M; Talbot, Norris C; Ahmadzadeh, Shahab; Shekoohi, Sahar; Cornett, Elyse M.; Kaye, Adam M.; Kaye, Alan D.

doi:10.1007/s12325-023-02435-y

Cited by 18 publications

(11 citation statements)

References 14 publications

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“…7 Significant adverse effects include autoimmune disease (e.g., drug-related lupus and serum sickness), pseudotumor cerebri/IIH, pulmonary toxicity and skin hyperpigmentation. 7 Reports of IIH have been published in literature previously, where minocycline was used for a variety of indications including acne, folliculitis and pelvic inflammatory disease, 6,8,9 However, ours appears to be the first report of such an occurrence in a patient with neoplastic disease, and serves to caution the clinician in maintaining vigilance when administering minocycline, and in differentiating IIH from the spread of the neoplasm to the CNS. It is pertinent to note here that IIH can be potentially reversible upon prompt discontinuation of minocycline.…”

Section: Commentsmentioning

confidence: 87%

Minocycline-induced diplopia in Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL): A case report.

Khattak

Mir

Ghani

et al. 2023

Preprint

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Background: Minocycline is frequently utilized for multiple drug- and extensively drug- resistant bacteria (XDR), but is associated with many side effects. Idiopathic intracranial hypertension is one such effect resulting from the precipitation of raised intracranial pressure (ICP), manifesting as headaches, diplopia or even vision loss. The aim of this study is to present a case of Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ ALL) with XDR Escherichia. coli (E. coli) treated with minocycline. This resulted in elevated ICP with associated symptoms which were initially thought to be due to central nervous system (CNS) involvement by primary disease. Case presentation: A 14-year-old girl was given minocycline therapy for XDR E. coli, which was cultured from her blood, for two weeks. Patient develop complaints of nausea, vomiting, headache blurring and doubling of vision one week into therapy. Lumbar puncture and brain imaging were performed to rule out CNS involvement with Ph+ ALL, which were reported as negative for malignancy. Minocycline was suspected to have precipitated the event and was discontinued. The patient recovered within one week after cessation of therapy. Conclusion: Minocycline can be associated with symptomatic elevation of intracranial pressure, which can easily be mistaken for CNS involvement in patients with neoplastic disease, and can reverse upon discontinuation of the drug.

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Section: Commentsmentioning

confidence: 87%

Minocycline-induced diplopia in Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL): A case report.

Khattak

Mir

Ghani

et al. 2023

Preprint

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“…Second, all previously reported cases had persistent symptoms of IH even after tetracyclines were stopped—with many requiring medical or procedural intervention to address the signs and symptoms of IH ( 18 , 22 , 23 ). Two of the reported cases required a ventriculoperitoneal shunt for symptom control, another needed optic nerve decompression, and others had chronic, stable vision loss.…”

Section: Discussionmentioning

confidence: 99%

Doxycycline-Induced Intracranial Hypertension Presenting as Unilateral Pulsatile Tinnitus

Ali,

Long,

Manzoor

et al. 2023

Otology &Amp; Neurotology Open

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Background: Pulsatile tinnitus (PT) is increasingly recognized as a cardinal symptom of idiopathic intracranial hypertension (IIH). However, clinicians should remain aware of other causes of nonidiopathic or secondary intracranial hypertension manifesting as PT. We present 2 patients with isolated PT (without accompanying headache, blurred vision, and papilledema) thought to be secondary to tetracycline-induced intracranial hypertension. To our knowledge, these are the first cases of PT as the presenting symptom of this condition. Cases: A 41-year-old female (body mass index [BMI] 29 kg/m2) with ocular rosacea was initially treated with minocycline. Shortly after transitioning to oral doxycycline and erythromycin eye ointment, she noted left-sided PT. Her PT resolved after discontinuing doxycycline. In a second case, a 39-year-old female (BMI 19 kg/m2) with acne presented with a three-year history of left-sided PT while on long-term oral doxycycline for many years. She denied visual or auditory changes and atypical headaches. MRI findings were concerning for intracranial hypertension. Three months later, the patient was seen by neuro-ophthalmology, with findings suggesting prior papilledema. The patient reported PT improvement after discontinuing doxycycline. Conclusions: This case series highlights 2 cases of isolated PT as the sole symptom of intracranial hypertension that resolved with tetracycline cessation. The presentation and unexpected improvement following tetracycline discontinuation are atypical compared with previous reports of tetracycline-induced intracranial hypertension. Clinicians should maintain a high index of suspicion for all types of intracranial hypertension (idiopathic and secondary), even in patients with a lower BMI. Current and prior medications should be reviewed when considering the etiology of intracranial hypertension.

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“…Less than 1% of patients experienced treatment failure, and over half of the cases were due to reinfection [36]. Doxycycline als has rare but possible side effects, including esophageal perforation, photosensitivity and pseudotumor cerebri [46]. A study comparing the effectiveness of doxycycline and cefuroxime in treating adult patients with erythema migrans found that 45 out of 51 patients receiving doxycycline and 51 out of 55 individuals taking cefuroxime exhibited satisfactory outcomes [47].…”

Section: Post-exposure Prophylaxis Following Tick Bite and Erythema M...mentioning

confidence: 99%

Current Treatment Approaches to Eliminate <em>Borrelia burgdorferi </em>and Potential Strategies to Alleviate Persistent Lyme Disease Symptoms

Zafar,

Azuama,

Parveen

2024

Preprint

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Lyme disease is a highly prevalent tick-borne infection caused by Borrelia burgdorferi spirochetes in North America and Eurasia. Diagnosis of the early disease remains difficult with the currently approved serological tests in the absence of noticeable tick bite or erythema migrans due to presentation of non-specific symptoms and the absence of antibodies early in infection. Furthermore, it is difficult to distinguish persistence of disease and reinfection in the endemic regions. If not treated early, infection spreads throughout the body and affects most organs with disease manifestations including arthritis, musculoskeletal pain, neuroborreliosis and acrodermatitis chronicum atrophicans. Although most patients recover after antibiotic treatment, ~10-12% of show recurrence of symptoms known as post-treatment Lyme disease syndrome (PTLDS). Various causes of PTLDS are not well-defined; however, the spirochete persisters, antigenic debris, dysregulation of immunological response in individuals or a combination of these factors are proposed to result in continuation of Lyme disease manifestations. Based on these considerations, this review highlights currently employed treatment approaches with antimicrobials and vaccines being tried for prevention of B. burgdorferi infection. We also summarize combinatorial approaches that could be employed to alleviate symptoms to improve the quality of life of the individuals suffering from long Lyme disease.

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Tetracycline-, Doxycycline-, Minocycline-Induced Pseudotumor Cerebri and Esophageal Perforation

Cited by 18 publications

References 14 publications

Minocycline-induced diplopia in Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL): A case report.

Minocycline-induced diplopia in Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL): A case report.

Doxycycline-Induced Intracranial Hypertension Presenting as Unilateral Pulsatile Tinnitus

Current Treatment Approaches to Eliminate <em>Borrelia burgdorferi </em>and Potential Strategies to Alleviate Persistent Lyme Disease Symptoms

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