Minocycline
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Renal polyarteritis nodosa: case report A 21-year-old woman developed renal polyarteritis nodosa (PAN) during treatment with minocycline for acne. The woman presented with several months of fatigue, weight loss, myalgias and severe bitemporal headaches. She also had polyuria, salt-craving, dyspnoea on exertion, easy bruising and pharyngitis. Her medications included minocycline [dosage and route not stated], which she had started taking 2 years prior [time to reaction onset not clearly stated]. She was both tachycardic and severely hypertensive on presentation, and she was hospitalised. She had electrolyte abnormalities, and she had a urine protein/creatinine ratio of 3500 mg/g. Her plasma renin activity and aldosterone level were 110 ng/mL/h and 89 ng/mL, respectively. An echocardiogram showed diminished ejection fraction. Proteinuria improved to 1680 mg/24h, and her BP improved. She had a CRP level of 4.3 mg/dL, and her ESR was 85 mm/h. Testing showed the presence of antimyeloperoxidase. Her hypertension and clinical picture suggested drug-induced PAN. Numerous microaneurysms were seen in the superior mesenteric arterial vasculature and kidneys with a renal arteriogram. Minocycline was withdrawn because it was the likely causative agent. The patient was treated with prednisone and cyclophosphamide. An ACE inhibitor was given for her hypertension. Her symptoms improved rapidly, and her hypertension was controlled well. Her CRP level and ESR normalised, and her ejection fraction improved slightly. Her proteinuria improved, and her urine dipstick was normal at last follow-up. Author comment: "The following is a case of minocyclineinduced PAN with renal and mesenteric artery involvement." Tabriziani H, et al. Minocycline-induced renal polyarteritis nodosa. BMJ Case Reports 2012: [4 pages], 13 Aug 2012. Available from: URL: http:// 803079255 dx.doi.org/10.1136/bcr-2012-006503 - USA
0114-9954/10/1426-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 3 Nov 2012 No. 1426
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