Minocycline
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Pneumonitis: case report A 51-year-old man developed pneumonitis during treatment with minocycline for a urinary tract infection (UTI). The man, who had a history of mycoplasma pneumonitis, was diagnosed with a UTI and started receiving minocycline 200 mg/day. He developed a fever after 11 days. Minocycline was replaced by cefotiam 2 days later. The man’s temperature decreased the following day, but he developed a dry cough. A chest x-ray revealed interstitial shadowing and he was hospitalised. On admission, he had an oxygen saturation of 92% and a WBC count of 11090/µL with 8% eosinophils; fine crackles were audible in both lung bases. Arterial blood gas analysis on oxygen revealed a pH of 7.465, a PaCO2 of 36.4 Torr, an HCO3 of -25.8 mmol/L, a PaO2 of 73.6 Torr and an alveolar-arterial oxygen difference of 70Torr. A CT scan confirmed pleural effusions and shadowing. Investigations of the pleural effusion revealed the following: specific gravity 1.016, pH 7.6, total protein 3.1 g/dL, albumin 1.9 g/dL, lactate dehydrogenase 155 IU/L, amylase 4 IU/L and 1+ lymphocytes. A lymphocyte stimulation test with minocycline was negative in the pleural effusion and in peripheral blood. Bronchoalveolar lavage showed the following values: recovery rate 72.2%, cell count 3.76 × 104 cell/mL, macrophages 82%, lymphocytes 1.2%, eosinophils 16.8%, CD3 69.1%, CD4 51.4% and CD8 16.2%. A lung biopsy confirmed aggregated macrophages and eosinophils within the alveoli. Minocyclineinduced pneumonitis was suspected. After minocycline was discontinued, the man’s fever subsided and chest x-rays improved. Drug-provocation tests were negative with 10mg and 100mg of minocycline. However, within 2 hours of internal administration of minocycline 100mg on day 3, he developed fever, bilateral ground glass shadowing, and elevations of his C-reactive protein level and WBC count. Minocycline-induced pneumonitis was confirmed. The man received methylprednisolone, with rapid improvement of fever and resolution of ground glass shadowing. Arai S, et al. A case of minocycline-induced pneumonitis with bilateral pleural effusion. Arerugi 56: 1293-1297, No. 10, Oct 2007 [Japanese; summarised from a 801079417 translation.] - Japan
0114-9954/10/1189-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 16 Feb 2008 No. 1189
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