title: Minocycline-induced cell-mediated hypersensitivity pneumonitis.
abstract: OBJECTIVE
  To identify the cause of a hypersensitivity pneumonitis and to determine its pathogenesis.
  
  
  METHODS
  Case study.
  
  
  METHODS
  Intensive care unit of a referral hospital.
  
  
  METHODS
  A 51-year-old man with chronic bronchitis who developed a hypersensitivity pneumonitis within 1 month after exposure to minocycline, amoxicillin, and erythromycin.
  
  
  METHODS
  Sequential bronchoalveolar lavages after reexposure to minocycline and amoxicillin.
  
  
  METHODS
  Immunologic analysis of the phenotype and function of alveolar lymphocytes.
  
  
  RESULTS
  Reexposure to minocycline but not to amoxicillin was followed by an interstitial pneumonitis. Sequential bronchoalveolar lavages showed a transient rise of eosinophils and neutrophils and a persistent alveolar lymphocytosis. Alveolar lymphocytes consisted predominantly of CD8+ but also CD4+ cells. Two CD8+ lymphocyte subsets were identified: CD8+ D44+ cytotoxic T cells that increased rapidly after the drug was resumed and CD8+ CD57+ suppressor T cells that predominated 11 days after the drug's withdrawal. In-vitro assays showed the presence of a lymphocyte-mediated specific cytotoxicity against minocycline-bearing alveolar macrophages.
  
  
  CONCLUSIONS
  These results support the hypothesis of a central role of T lymphocytes in the pathogenesis of drug-related hypersensitivity pneumonitis.
authors.affiliation: Hôpital Tenon, Paris, France.
authors.forename: J M
authors.initials: JM
authors.lastname: Guillon
authors.forename: P
authors.initials: P
authors.lastname: Joly
authors.forename: B
authors.initials: B
authors.lastname: Autran
authors.forename: M
authors.initials: M
authors.lastname: Denis
authors.forename: G
authors.initials: G
authors.lastname: Akoun
authors.forename: P
authors.initials: P
authors.lastname: Debré
authors.forename: C
authors.initials: C
authors.lastname: Mayaud
mesh_terms: D000542:Alveolitis, Extrinsic Allergic / Q000139:chemically induced* / Q000276:immunology; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology; D003602:Cytotoxicity, Immunologic; D004342:Drug Hypersensitivity / Q000209:etiology* / Q000276:immunology; D006801:Humans; D007111:Immunity, Cellular; D016130:Immunophenotyping; D007958:Leukocyte Count; D016676:Macrophages, Alveolar / Q000276:immunology; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000009:adverse effects*; D011650:Pulmonary Alveoli / Q000276:immunology; D013601:T-Lymphocytes / Q000276:immunology
chemical_list: D008911:Minocycline