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Polyarteritis nodosa-like vasculitis in association with minocycline use: a single-center case series

Tanaz A Kermani1, Erin K Ham, Michael J Camilleri

  • 1Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA. kermani.tanaz@yahoomail.com

Seminars in Arthritis and Rheumatism
|June 19, 2012
PubMed
Abstract

Insights

Minocycline can cause polyarteritis nodosa (PAN)-like vasculitis, affecting skin or organs. Discontinuation of minocycline and immunosuppressants are key treatments for this drug-induced vasculitis.

Area of Science:

  • Rheumatology
  • Dermatology
  • Internal Medicine

Background:

  • Polyarteritis nodosa (PAN) is a rare systemic vasculitis.
  • Minocycline is an antibiotic used for various infections and inflammatory conditions.
  • Drug-induced vasculitis is an important differential diagnosis in patients presenting with vasculitic symptoms.

Purpose of the Study:

  • To investigate the clinical presentation, treatment strategies, and outcomes of patients developing PAN-like vasculitis.
  • To determine the association between minocycline therapy and the onset of PAN-like vasculitis.
  • To raise awareness among clinicians regarding this potential adverse effect of minocycline.

Main Methods:

  • Retrospective review of patients diagnosed with PAN-like vasculitis and minocycline use.
  • Inclusion criteria: age ≥18 years, minocycline use at symptom onset, exclusion of hepatitis B-associated PAN.
  • Diagnostic confirmation through angiography or tissue biopsy.

Main Results:

  • Nine patients (56% female, median age 30) were identified.
  • 56% presented with systemic involvement (e.g., renal artery microaneurysms, mesenteric vasculitis).
  • Diagnosis confirmed by histopathology (67%) or angiography (33%); minocycline was discontinued in all cases.

Conclusions:

  • Minocycline therapy can be associated with the development of PAN-like vasculitis, both cutaneous and systemic.
  • Clinicians should consider minocycline as a potential cause of medium-vessel vasculitis.
  • Atypical ANCA serologies or negative hepatitis B testing in the context of vasculitis should prompt consideration of drug-induced causes.

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