RE:monocycline

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http://www.medscape.com/viewarticle/434359?srcmp=ms-07050

Table of Contents

Introduction

Case Report

Discussion

References

Severe Complication of a Commonly

Prescribed Drug: Minocycline-Induced

Lupus

from Journal of the American Board of Family

Practice

Shepherd, MD

Introduction

May you never outlive your children.

-- Native American proverb

The constellation of symptoms that includes

persistent fever, weight loss, general

malaise with rash, myalgias, and arthritis

brings a number of serious conditions into

consideration: malignancies, connective tissue

diseases, and systemic infections.

Drug-induced complications also fall into this

differential diagnosis. Drug-induced

lupus is most commonly associated with

procainamide (first described in 1962),

hydralazine, chlorpromazine, isoniazid,

a-methyldopa, and quinidine. From 46 to 70

drugs can cause drug-induced lupus, with the

first probable case caused by

sulfadiazine, published in 1945, and the first

definite causal relation with hydralazine

described in 1953.[1-3] Reports have also

implicated the lipid-soluble semisynthetic

tetracycline, minocycline, used as a

disease-modifying agent for reactive rheumatoid

arthritis and for acne.[1,2,4-14]

In 1959, 3 patients were reported to have

developed a systemic lupus

erythematosus (SLE-like) syndrome after taking

tetracycline.[4] Since then no other

cases of tetracycline-caused drug-induced lupus

have appeared. The first case of

minocycline-induced lupus was described in

1991.[4,5,14]

Many adolescents come to their family

physicians with concerns relating to

acneiform changes in their skin, and 65% of all

prescriptions for minocycline are

written for acne.[7] Fifty-seven cases of

minocycline-caused systemic lupus have

appeared in the medical literature. None,

however, has been published in a family

medicine journal.[4] Given the frequency of

diagnosis of acne and the common

prescription of minocycline, the possibility of

severe adverse reactions from this

drug needs recognition.

Section 1 of 3

Shepherd, MD, Department of Family

Medicine, School of Medicine, University

of Colorado Health Sciences Center, Denver.

J Am Board Fam Pract 15(3):239-241, 2002. ©

2002 American Board of Family Practice

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