Minocycline-induced Lupus in Adolescents

Abstract

Minocycline is a semisynthetic tetracycline antibiotic with a prolonged half-life. Its chief indications are the treatment of Rickettsia , Mycoplasma, Chlamydia , and Brucella infections, but it is also commonly used for the treatment of acne in doses of 50 to 100 mg daily.1 Its side effects include skin and tooth discoloration, gastrointestinal intolerance, hemolytic anemia, elevations in blood urea nitrogen, pneumonitis, and hepatitis. Also, a minocycline-related lupus-like syndrome presenting with findings including fever, arthritis, and rash has been reported mostly in young adults.2-7 We report five adolescent girls who developed lupus-like syndromes during treatment with minocycline for acne, so as to promote physician awareness, as differentiating this syndrome from genuine systemic lupus erythematosus (SLE) has important therapeutic and prognostic implications. The patients were girls ranging in age from 14 to 17 years who were referred to the pediatric rheumatology clinic at the Floating Hospital for Children by their primary pediatricians because of suspected lupus or other rheumatic disease. Drug exposures were sought during routine history taking. Serologic tests were performed at the New England Medical Center using standard methods. Antihistone antibodies were assayed at a commercial laboratory (Smithkline Beecham, Framingham, MA). ### Case Report Patient 2, a 16-year-old girl, presented with 2 weeks of daily fevers, fatigue, and diffuse arthralgias beginning 12 hours after receiving hepatitis B and diphteria–tetanus vaccines. She had been taking minocycline for a year as treatment for …