title: Minocycline-induced hypersensitivity syndrome presenting with meningitis and brain edema: a case report.
abstract: BACKGROUND
  Hypersentivity Syndrome (HS) may be a life-threatening condition. It frequently presents with fever, rash, eosinophilia and systemic manifestations. Mortality can be as high as 10% and is primarily due to hepatic failure. We describe what we believe to be the first case of minocycline-induced HS with accompanying lymphocytic meningitis and cerebral edema reported in the literature.
  
  
  METHODS
  A 31-year-old HIV-positive female of African origin presented with acute fever, lymphocytic meningitis, brain edema, rash, eosinophilia, and cytolytic hepatitis. She had been started on minocycline for inflammatory acne 21 days prior to the onset of symptoms. HS was diagnosed clinically and after exclusion of infectious causes. Minocycline was withdrawn and steroids were administered from the second day after presentation because of the severity of the symptoms. All signs resolved by the seventh day and steroids were tailed off over a period of 8 months.
  
  
  CONCLUSIONS
  Clinicians should maintain a high index of suspicion for serious adverse reactions to minocycline including lymphocytic meningitis and cerebral edema among HIV-positive patients, especially if they are of African origin. Safer alternatives should be considered for treatment of acne vulgaris. Early recognition of the symptoms and prompt withdrawal of the drug are important to improve the outcome.
authors.affiliation: Department of Infectious Diseases and Tropical medicine, Teaching Hospital, Strasbourg, France. n.lefebvre@yahoo.fr.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lefebvre
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Forestier
authors.forename: David
authors.initials: D
authors.lastname: Farhi
authors.forename: Mohseni Zadeh
authors.initials: MZ
authors.lastname: Mahsa
authors.forename: Véronique
authors.initials: V
authors.lastname: Remy
authors.forename: Olivier
authors.initials: O
authors.lastname: Lesens
authors.forename: Daniel
authors.initials: D
authors.lastname: Christmann
authors.forename: Yves
authors.initials: Y
authors.lastname: Hansmann