ANCA-positive crescentic glomerulonephritis associated with minocycline therapy.
Minocycline is an oral antibiotic widely used for the long-term treatment of acne and rheumatoid arthritis. A few patients develop antineutrophil cytoplasmic antibodies (ANCAs) during minocycline therapy. In this report, the authors describe a case of severe pauci-immune crescentic and necrotizing glomerulonephritis associated with positive cytoplasmic ANCA (C-ANCA) titers and proteinase 3 (PR3) levels after minocycline therapy. Discontinuation of minocycline and initiation of immunosuppressive treatment resulted in improvement of renal function and decline in C-ANCA titers and PR3 levels. A high degree of suspicion, testing for ANCA titers, prompt discontinuation of the drug, and initiation of immunosuppressive treatment are crucial to the diagnosis and treatment of drug-induced ANCA-associated glomerulonephritis.
Sethi
Sanjeev
S
Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA. sanjeev-sethi@uiowa.edu
Sahani
Mandeep
M
Oei
Liem Som
LS
D000328:Adult; D000818:Animals; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000032:analysis*; D018771:Arthralgia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy; D001327:Autoimmune Diseases / Q000139:chemically induced* / Q000188:drug therapy / Q000276:immunology; D001733:Bites and Stings; D003951:Diagnostic Errors; D005260:Female; D005921:Glomerulonephritis / Q000139:chemically induced* / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008911:Minocycline / Q000009:adverse effects*; D053146:Myeloblastin; D012697:Serine Endopeptidases / Q000276:immunology; D013987:Ticks
D019268:Antibodies, Antineutrophil Cytoplasmic; D007166:Immunosuppressive Agents; D012697:Serine Endopeptidases; D053146:Myeloblastin; D008911:Minocycline