Polyarteritis nodosa-like vasculitis in association with minocycline use: a single-center case series.
OBJECTIVE
To describe the clinical features, treatment, and outcomes of polyarteritis nodosa (PAN)-like vasculitis in association with minocycline therapy.


METHODS
We identified all subjects ≥18 years old with PAN-like vasculitis in the context of minocycline use seen at our institution between January 1995 and October 2010. Cases of hepatitis B-associated PAN were excluded. PAN was defined based on angiographic findings or tissue biopsy. Minocycline use was defined as medication use at the time of onset of first symptom.


RESULTS
We identified 9 patients (5 females; 56%) with a median age of 30 (range 18 to 55) years. Four patients (44%) had isolated cutaneous disease, while 5 cases (56%) had systemic involvement including renal artery microaneurysms (2 patients), cholecystitis (1 patient), mononeuritis multiplex (2 patients), and mesenteric vasculitis (1 patient). Median duration of minocycline use was 2 (range 1 to 4) years. Three patients had a positive antinuclear antibody with negative extractable nuclear antigen antibodies. All patients had positive antineutrophil cytoplasmic antibody in a perinuclear pattern but specificity to myeloperoxidase was observed in 2 patients (22%). Diagnosis was confirmed by histopathology in 6 patients (67%) and angiography in 3 patients (33%). Minocycline was discontinued in all cases. Further immunosuppressive therapy was added in 6 cases (67%).


CONCLUSIONS
Cutaneous, as well as systemic, PAN-like vasculitis may occur in association with minocycline use. Clinicians should consider the possibility of drug-induced vasculitis, especially in cases of medium-vessel vasculitis with atypical antineutrophil cytoplasmic antibody serologies or in patients with negative hepatitis B testing.
Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA. kermani.tanaz@yahoomail.com
Tanaz A
TA
Kermani
Erin K
EK
Ham
Michael J
MJ
Camilleri
Kenneth J
KJ
Warrington
D000152:Acne Vulgaris / Q000188:drug therapy; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D000974:Antibodies, Antinuclear / Q000097:blood; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000009:adverse effects*; D010488:Polyarteritis Nodosa / Q000097:blood / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology; D055815:Young Adult
D000900:Anti-Bacterial Agents; D000974:Antibodies, Antinuclear; D007166:Immunosuppressive Agents; D008911:Minocycline