Antineutrophil cytoplasmic antibodies and HLA class II alleles in minocycline-induced lupus-like syndrome.
We report 14 patients with minocycline-induced lupus-like syndrome (four men, 10 women; mean age 27.8 years) who developed a lupus-like illness after chronic use of minocycline for acne (1-10 years, median 3.8). Clinical features resolved completely on drug withdrawal (mean follow-up 11 months) and reappeared in two patients who were rechallenged. Sera from all 14 patients contained antineutrophil cytoplasmic antibodies (ANCA) giving a perinuclear pattern on indirect immunofluorescence on ethanol-fixed human neutrophils (p-ANCA), whereas 14 control asymptomatic individuals taking minocycline for acne were ANCA-negative. Eleven of the 14 patients had elevated antimyeloperoxidase antibodies and 10 had antielastase antibodies on enzyme-linked immunosorbent assay, which diminished on extended follow-up, as did other serological abnormalities. Major histocompatibility complex class II typing demonstrated that all of the 13 patients tested were either HLA-DR4 (nine of 13) or HLA-DR2 (four of 13) positive, and all had an HLA-DQB1 allele encoding for tyrosine at position 30 of the first domain. Our findings suggest a model whereby the presence of p-ANCA may be a marker for the development of lupus-like symptoms in genetically susceptible individuals taking minocycline for acne.
Dunphy
J
J
Royal National Hospital for Rheumatic Diseases, Upper Borough Walls, Bath BA1 1RL, U.K.
Oliver
M
M
Rands
A L
AL
Lovell
C R
CR
McHugh
N J
NJ
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D005819:Genetic Markers; D020022:Genetic Predisposition to Disease; D006683:HLA-DQ Antigens / Q000097:blood* / Q000235:genetics; D006684:HLA-DR Antigens / Q000097:blood* / Q000235:genetics; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000139:chemically induced* / Q000235:genetics / Q000276:immunology*; D008297:Male; D008911:Minocycline / Q000009:adverse effects*
D000900:Anti-Bacterial Agents; D019268:Antibodies, Antineutrophil Cytoplasmic; D005819:Genetic Markers; D006683:HLA-DQ Antigens; D006684:HLA-DR Antigens; D008911:Minocycline