Severe minocycline-induced eosinophilic pneumonia: extrapulmonary manifestations and the use of in vitro immunoassays.
OBJECTIVE
To report a severe and unusual reaction to minocycline and the use of in vitro immunologic assays.


METHODS
A 46-year-old white man developed severe respiratory distress with pulmonary infiltrates on chest X-ray and eosinophilia in blood, bronchoalveolar lavage fluid, and biopsied lung tissue during exposure to minocycline. Additional manifestations included pleuropericardial effusion, liver function abnormality, and bone marrow eosinophilia. Macrophage inhibition factor and mast cell degranulation assays were positive to minocycline.


CONCLUSIONS
The patient's manifestations were compatible with the diagnosis of eosinophilic pneumonia. After excluding other possible etiologies, minocycline was identified as the offending agent. Generalized damage was suggested by the presence of a combination of extrapulmonary manifestations previously not reported. Results of the in vitro immunologic assays supported the hypersensitivity nature of the disease and confirmed the diagnosis.


CONCLUSIONS
Minocycline-induced eosinophilic pneumonia may involve extrapulmonary sites. It is suggested that in vitro immunoassays be used for confirmation of the diagnosis rather than rechallenge or invasive procedures.
Bentur
L
L
Division of Pulmonary Diseases, Rambam Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Bar-Kana
Y
Y
Livni
E
E
Finkelstein
R
R
Ben-Izhak
O
O
Keidar
S
S
Bentur
Y
Y
D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015550:Cell Degranulation; D006801:Humans; D007118:Immunoassay; D008263:Macrophage Migration-Inhibitory Factors / Q000032:analysis; D008297:Male; D008407:Mast Cells / Q000502:physiology; D008875:Middle Aged; D008911:Minocycline / Q000009:adverse effects* / Q000627:therapeutic use; D011657:Pulmonary Eosinophilia / Q000139:chemically induced* / Q000175:diagnosis
D000900:Anti-Bacterial Agents; D008263:Macrophage Migration-Inhibitory Factors; D008911:Minocycline