[Acute respiratory failure caused by minocycline]

In the case of pneumonia an infectious cause is always considered first. However, toxic agents and medicines can also be the cause of pneumonia.

A 54-year-old woman was referred to the emergency department because of progressive dyspnoea, a non-productive cough, headache, and fever. She was admitted with the diagnosis community acquired pneumonia. Despite treatment with antibiotics and oxygen she developed hypoxic respiratory failure, which necessitated invasive mechanical ventilation. Imaging diagnostics showed extensive bilateral pulmonary consolidation, despite the absence of a causative agent in cultures. Further medical history-taking revealed that the patient had recently commenced a course of minocycline. She had used this medicine previously and had twice before developed pneumonia without the presence of a proven causative agent. Our differential diagnosis included the toxic effect of minocycline and we treated the patient with methylprednisolone. This resulted in rapid clinical improvement and full recovery of our patient.

Acute respiratory failure as a side effect of medication is rare, but nonetheless potentially life-threatening. Despite repeated exposure to minocycline, the link with pneumonia was not previously made in this patient.