Minocycline-related autoimmune hepatitis: case series and literature review.
BACKGROUND
Minocycline is an antibiotic commonly used in the treatment of adolescent acne.


OBJECTIVE
To describe the clinical, laboratory, and histological features in 3 cases of minocycline-related autoimmune hepatitis and to review the literature of similar cases in the adolescent population.


METHODS
Case series.


METHODS
Patients were cared for in the Division of Gastroenterology, Children's Hospital, Boston, Mass.


RESULTS
Three adolescents (age, 15-16 years), while being treated with therapeutic doses of minocycline for periods of 12 to 20 months, met the 1993 International Autoimmune Hepatitis Group criteria for autoimmune hepatitis. All had a positive antinuclear antibody titer. Other features included hypergammaglobulinemia and a positive anti-smooth muscle antibody titer. Two patients underwent liver biopsy that revealed severe chronic lymphoplasmacytic inflammation, necrosis, and fibrosis. All other causes of liver disease were excluded. One patient had resolution of symptoms with withdrawal of the drug, while 2 required immunosuppression therapy. A review of the literature yielded only 18 similar cases, none in the pediatric literature, the majority of which contained incomplete pertinent data.


CONCLUSIONS
Minocycline is related to the development of autoimmune hepatitis in some adolescents. Pediatricians who use this drug for treatment of acne should be aware of this serious potential relation and stop the drug immediately when suspicion is raised.
Teitelbaum
J E
JE
Combined Program in Gastroenterology and Nutrition, Children's Hospital, Harvard Medical School, Boston, Mass 02115, USA.
Perez-Atayde
A R
AR
Cohen
M
M
Bousvaros
A
A
Jonas
M M
MM
D000152:Acne Vulgaris / Q000188:drug therapy; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D056487:Chemical and Drug Induced Liver Injury, Chronic / Q000453:epidemiology / Q000209:etiology; D005260:Female; D019693:Hepatitis, Autoimmune / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008297:Male; D008911:Minocycline / Q000009:adverse effects* / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D008911:Minocycline