title: Perinuclear antineutrophilic cytoplasmic antibody-positive cutaneous polyarteritis nodosa associated with minocycline therapy for acne vulgaris.
abstract: Minocycline is an oral antibiotic widely used for the long-term treatment of acne vulgaris. Unusual side effects of this medication include two overlapping autoimmune syndromes: drug-induced lupus and autoimmune hepatitis. In addition, in a few patients livedo reticularis or subcutaneous nodules have developed in association with arthritis and serum perinuclear antineutrophil cytoplasmic antibodies (P-ANCA) during long-term minocycline therapy. We report the cases of two young women receiving long-term minocycline therapy (>3 years) in whom P-ANCA-positive cutaneous polyarteritis nodosa developed. Both patients presented with a violaceous reticulated pattern on the lower extremities. Histologic examination of biopsy specimens from a reticulated area and a subcutaneous nodule showed necrotizing vasculitis of medium-sized arteries in the deep dermis, consistent with the diagnosis of polyarteritis nodosa. The cutaneous lesions rapidly resolved on discontinuation of minocycline and initiation of prednisone therapy. A high index of suspicion and testing for antineutrophil cytoplasmic antibody in addition to the standard antinuclear antibody panel can facilitate diagnosis of minocycline-related autoimmune disorders.
authors.affiliation: Department of Dermatology, Yale University School of Medicine, New Haven CT, USA.
authors.forename: J V
authors.initials: JV
authors.lastname: Schaffer
authors.forename: D M
authors.initials: DM
authors.lastname: Davidson
authors.forename: J M
authors.initials: JM
authors.lastname: McNiff
authors.forename: J L
authors.initials: JL
authors.lastname: Bolognia
mesh_terms: D000152:Acne Vulgaris / Q000188:drug therapy*; D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood*; D003875:Drug Eruptions / Q000209:etiology*; D005260:Female; D006801:Humans; D007868:Leg Dermatoses / Q000139:chemically induced; D008911:Minocycline / Q000009:adverse effects* / Q000627:therapeutic use; D010488:Polyarteritis Nodosa / Q000139:chemically induced* / Q000276:immunology; D017445:Skin Diseases, Vascular / Q000139:chemically induced* / Q000276:immunology
chemical_list: D000900:Anti-Bacterial Agents; D019268:Antibodies, Antineutrophil Cytoplasmic; D008911:Minocycline