[Minocycline-induced neutrophilic alveolitis?]

A 53-year-old man was treated for hypoxic pneumonia. Alveolar lavage revealed neutrophilic alveolitis and search for an infectious agent was negative. Lung biopsy revealed discrete endo-alveolar edema and polymorphous infiltration in moderately thickened alveolar walls. After 17 days, an ineffective antibiotic regimen was replaced by corticosteroids. Clinical and radiological signs improved in a few days and pneumonia did not recur after corticosteroid withdrawal. The most likely causal agent was minocycline which the patient had received for two Years for the treatment of rhinophyma. Minocycline had been interrupted several weeks when the pulmonary disorder developed after re-introduction of minocycline. Different clinical manifestations of minocycline-induced lung disease have been described including eosinophilic pneumopathy, bronchiolitis obliterans with organized pneumonitis, and hypersensitivity pneumonitis. There has only been one report of polymorphonuclear neutrophils observed in the lavage fluid.